Efficacy and Safety of Transbrachial Access for Iliac Endovascular Interventions

Stavroulakis, Konstantinos; Usai, Marco V.; Torsello, Giovanni; Schwindt, Arne; Stachmann, Arne; Beropoulis, Efthymios; Bisdas, Theodosios

doi:10.1177/1526602816640522

Cited by 41 publications

(26 citation statements)

References 28 publications

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“…For example, brachial access would increase the probability of crossing for a ush iliac artery occlusion, which is a CTO lesion without a stump in the origin of the CIA. The guidewire and catheter approaches from the contralateral femoral artery are prone to slipping in the aorta because of the lack of required support [4,8]. As shown in our study, the presence of a stump in the CTO lesions was associated with the use of contralateral access (72% vs. 27%).…”

Section: Discussionmentioning

confidence: 52%

Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

Zhang

Niu

et al. 2020

Preprint

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Background: The iliac occlusive disease is usually treated with endovascular procedures in recent years. The effectiveness of different crossing approaches for these occlusions is not precisely known. We performed a retrospective study to explore the optimal crossing approach (antegrade versus retrograde) for iliac artery chronic total occlusions (CTOs) and to examine the long-term outcomes. Materials and Methods: We performed a study on 107 patients (116 iliac occlusive lesions, mean age 64.0±11.1, 88 men) who underwent an iliac CTO endovascular intervention attempted with the use of both crossing strategies but were managed with one final crossing approach between August 2012 and August 2018. Baseline data, procedural characteristics, and outcomes were described. A Cox proportional hazard model and Kaplan-Meier method were developed to assess the differences in the two crossing approaches in terms of the 1-year and 5-year primary patency rates, target lesion revascularization (TLR ) and major adverse limb events (MALEs ). Results: Common iliac artery (CIA ) lesions were more likely to be crossed successfully in the retrograde direction (6.8% for antegrade vs. 20.9% for retrograde, p=0.005), while lesions in the CIA/ external iliac artery (EIA ) were more prone to be crossed successfully in the antegrade direction (58.9% for antegrade vs. 39.5% for retrograde, p=0.016). There were no significant differences in the crossing approach for EIA lesions between the two groups. The two crossing approaches were associated with similar estimates of 1- and 5-year primary patency, TLR and MALE rates. Conclusion: The antegrade approach was associated with a higher rate of successful crossing in CIA/EIA CTO lesions, while the CIA-only CTOs were more likely to be crossed successfully with the retrograde approach.

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Section: Discussionmentioning

confidence: 52%

Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

Zhang

Niu

et al. 2020

Preprint

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“…22,24,25) The use of long sheaths has been described as a risk factor for upper-arm access complications, which occur in 1-6.5% of coronary or peripheral artery interventions. 26,27) Because we inserted large long sheaths into the brachial artery, our series showed a higher incidence of local complications than previous reports have shown. In the latter half of our series, however, our new method of staged manual compression completely abolished any local complications involving brachial hematoma.…”

Section: Discussionmentioning

confidence: 59%

Cerebral Ischemic Complications of Subclavian Artery Stenting: Relationship between Lesion Location and Procedural Strategy

Arihara

Miyata

Iihoshi

et al. 2019

JNET

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Clinical research demonstrating safety and security in subclavian artery stenting (SAS) is limited because treatment strategies for SAS vary greatly among institutions, operators, and clinical conditions, as no standard protocol exists. As stenotic lesions frequently occur in the proximal portion of the subclavian artery (SA), it is often difficult to stabilize the guiding catheter for stent delivery. Our purpose was to assess whether lesion location can be used to predict optimal procedural strategies. Methods: We performed a retrospective, single-center observational study on 26 consecutive patients who underwent SAS between 2004 and 2016. We categorized patients treated with SAS into two groups according to lesion location: those with lesions located less than 10 mm from the origin of the SA (Group P) and those with lesions in the distal portion (Group D). We defined a bidirectional approach via both brachial and femoral puncture as well as bilateral brachial puncture as combined access. In pull-through method, a guidewire was passed from one sheath to another. We compared Group P with Group D in terms of procedural strategy and efficacy. Results: All 26 cases were clinically successful. Asymptomatic cerebral embolism was found in 10 (48%) of 21 cases in which postoperative MRI was performed, and the number of spotty lesions was less than four in every patient. Arterial access-site complications were documented in eight patients. Two cases of late in-stent restenosis were retreated with balloon dilatation. Cases with retrograde ipsilateral vertebral artery (VA) blood flow and symptomatic lesions occurred more frequently in Group P than in Group D (79% vs. 42%; p = 0.06, 71% vs. 33%; p = 0.05, respectively). Patients in Group P were significantly more often treated with combined access (100% vs. 42%; p = 0.001), with the pull-through method (64% vs. 0%; p < 0.001) than those in Group D. The distal end of the stent was involved with the ipsilateral VA orifice more often in Group D than in Group P (50% vs. 7%; p = 0.02). Conclusion: These results demonstrate that our strategy is a safe and effective method of stenting for SA stenosis in the portion of the artery that is proximal to the aorta. We should pay special attention to the risk of arterial access-site complications. Keywords▶ subclavian artery occlusive disease, stenting, endovascular therapy, cerebral embolism This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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“…The only proven independent risk factor for increased complication rate in brachial access is female gender. 25 Achieving hemostasis is most accomplished often via manual pressure. Using ultrasound-guided compression can help ensure adequate pressure is being applied directly over the arteriotomy site.…”

Section: Alternative Arterial Accessmentioning

confidence: 99%

Percutaneous Endovascular Aneurysm Repair: Current Status and Future Trends

Watts

2020

Semin intervent Radiol

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Endovascular aneurysm repair (EVAR) is a common, safe, and effective method of treating abdominal aortic aneurysms. Traditionally treated via surgical cutdown over the common femoral arteries, many recent studies demonstrate percutaneous access techniques to avoid the surgical cutdown. Developing familiarity with these percutaneous techniques, including risks, complications, adjuncts, and alternative accesses, can help improve the outcomes and availability of EVAR. As these techniques become increasingly common, it is not unlikely that they can be practiced safely in select patients in an outpatient setting.

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Efficacy and Safety of Transbrachial Access for Iliac Endovascular Interventions

Cited by 41 publications

References 28 publications

Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

Effectiveness and Long-term Outcomes of Different Crossing Strategies for the Endovascular Treatment of Iliac Artery Chronic Total Occlusions

Cerebral Ischemic Complications of Subclavian Artery Stenting: Relationship between Lesion Location and Procedural Strategy

Percutaneous Endovascular Aneurysm Repair: Current Status and Future Trends

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