Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series

Abecassis, Isaac Josh; Saini, Vasu; Phillips, Timothy J; Osbun, Joshua W.; Martínez‐Galdámez, Mario; Nada, Ahmed; Levitt, Michael R.; Crowley, R. Webster; Sattur, Mithun G.; Spiotta, Alejandro M; Luther, Evan; Chen, Stephanie H.; Burks, Joshua D.; Jabbour, Pascal; Sweid, Ahmad; Psychogios, Marios; Park, Min S; Yavagal, Dileep R.; Peterson, Eric C.; Waqas, Muhammad; Dossani, Rimal H; Davies, Jason M; Selkirk, Gregory D; Fox, W. Christopher; Abud, Daniel Giansante; Fernández, Jorge Galván; Arteaga, Miguel Schüller; Starke, Robert M.

doi:10.1136/neurintsurg-2020-017102

Cited by 13 publications

(11 citation statements)

References 14 publications

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“…The authors present the cases of two patients undergoing combined TRA and UETV for CCF embolization. UETV has been well-explored in interventional cardiology literature, but there are few studies in the neurointerventional literature, as UETV is still an emerging strategy in the field [1]. Combined arterial and venous access in the arm has gained additional traction in interventional cardiology due to the possibility of patients continuing anticoagulation and thereby avoiding thromboembolic events that might occur when anticoagulation is held, which is particularly relevant in cardiac patients.…”

Section: Discussionmentioning

confidence: 99%

“…There was a 9% failure rate using upper extremity TVA due to small venous size, occlusion, or inability to access [7]. Another prospective study on 1007 patients analyzed arm and femoral access for cardiac procedures and found shorter procedure duration and fluoroscopy time, with lower radiation doses and rates of hematoma in the arm group [1].…”

Section: Discussionmentioning

confidence: 99%

“…Radial artery access for transarterial procedures has gained recent traction among neurointerventionalists due to technical feasibility, decreased patient morbidity, and improved patient satisfaction. Upper extremity transvenous access (UETV) has also emerged as an alternative strategy for neurointerventionalists, but data are limited [1]. The authors' objectives were to quantify the use of UETV and measure failure and access complications.…”

Section: Introductionmentioning

confidence: 99%

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Combined Transradial and Upper Extremity Transvenous Accesses in the Treatment of Carotid-Cavernous Fistulae: Two Case Reports and a Literature Review

Babici¹,

Johansen²,

Carranza³

et al. 2022

Cureus

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The expansion of indications for neurointerventional procedures, combined with the need to treat a diverse patient population, has driven a need for broader access options. Concurrent arterial and venous access is often necessary for the diagnosis and treatment of various neurovascular diseases. Although complication rates are low, life-threatening severe complications have been reported with these access methods. Moreover, venous access through traditional routes can be challenging in patients with large body habitus. There is a growing trend of utilizing radial artery access for neuroendovascular procedures due to the increased ease of access and similar efficacy. Nevertheless, the use of upper limb veins in neurointerventional procedures is still rare. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for neurointerventionalists, but data are limited. This study reports two cases of successful combined upper extremity transvenous access (TVA) and transradial access (TRA) in the treatment of carotid artery-cavernous fistulae. Combined TRA and UETV is a feasible, promising access strategy for patients and may also confer the same safety and patient satisfaction outcomes that have been seen with TRA. Further studies are needed to elucidate the exact impact this strategy has on patient outcomes and satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined Transradial and Upper Extremity Transvenous Accesses in the Treatment of Carotid-Cavernous Fistulae: Two Case Reports and a Literature Review

Babici¹,

Johansen²,

Carranza³

et al. 2022

Cureus

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“…Other uncommon but serious adverse events in transfemoral or transjugular venous approaches include pneumothorax, hematoma formation compromising the airway, and plexus injury, all of which can be avoided if performing a superficial upper limb veins access. 11 In a multicenter case series by Abecassis et al 15 , patients who underwent superficial upper limb veins for neuro-interventional procedures had no adverse complications, with only 3.4% of the patients requiring conversion to the transfemoral venous approach.…”

Section: D E F a Bmentioning

confidence: 98%

Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein

2021

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Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients’ comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.

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“…Advanced cone-beam computed tomography venous imaging is helpful. 20 Although not used in this series, other points of venous access (eg, upper extremity 21 and direct internal jugular puncture 22 ) may shorten the distance needed to access a fistula and avoid traversal of the right atrium. As has been used for transvenous arteriovenous malformation embolization 23 in this series, 24 placing an arterial balloon can assist in venous retrograde navigation and help protect against retrograde embolization with liquid embolics.…”

Section: Technical Nuancesmentioning

confidence: 99%

Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

Srinivasan,

Karahalios,

Colasurdo

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Arteriovenous fistulas involving the deep venous system have often been treated with microsurgery or transarterial embolization. Increasing familiarity with transvenous navigation and improved endovascular access systems may facilitate transvenous embolization (TVE) for these rare and challenging lesions. METHODS: We performed a retrospective study of neurointerventional databases of 6 high-volume centers. We identified all cases of arteriovenous fistulas with deep transvenous embolizations for arteriovenous fistula. Details regarding demographics, fistula characteristics, treatment considerations, clinical outcomes, and fistula occlusion were obtained and analyzed. The meta-analysis used the same inclusion criteria. RESULTS: Seventeen cases of TVE were identified. The most common reasons for TVE included prior treatment failure with microsurgery (n = 2) or transarterial embolization (n = 3) or inaccessible arterial pedicles (n = 4). For patients with full clinical outcome data (n = 14), 2 patients had worsened modified Rankin Scale, 8 patients had no change, and 4 were improved at a median clinical follow-up of 3.5 months. Angiographic obliteration was achieved in 15/17 cases (88.2%). In 1 case, catheterization around a sharp turn in the basal vein of Rosenthal could not be performed. In another case, despite successful TVE, there was residual lesion which was treated 1 year later by microsurgical clipping and excision. CONCLUSION: Transvenous approaches for embolization of deep arteriovenous fistulas have become possible with modern endovascular catheter systems and liquid embolics. These lesions can be treated safely and effectively through endovascular approaches, which may spare patients the traversal of deep structures needed for microsurgical approaches to these regions. The outcomes of TVE are comparable with published outcomes of microsurgical interruption.

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Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series

Cited by 13 publications

References 14 publications

Combined Transradial and Upper Extremity Transvenous Accesses in the Treatment of Carotid-Cavernous Fistulae: Two Case Reports and a Literature Review

Combined Transradial and Upper Extremity Transvenous Accesses in the Treatment of Carotid-Cavernous Fistulae: Two Case Reports and a Literature Review

Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein

Transvenous Embolization of Dural Arteriovenous Fistulas Through the Galenic (Deep Venous) System: Multicenter Case Series and Meta-Analysis

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