Back to 2016 Annual Symposium ePosters
Right axillary artery cutdown for renovisceral stents during chimney EVAR is safe and effective
Charles S. Briggs, MD, William Bevilacqua, MD, Trissa Babrowski, MD, Robert Steppacher, MD, Ross Milner, MD.
University of Chicago Medical Center, Chicago, IL, USA.
OBJECTIVES:
Endovascular aortic aneurysm repair using the chimney technique (ch-EVAR) has been shown to be feasible in both acute and elective cases with good results. The early experience with ch-EVAR has utilized the left axillary or brachial artery for access to the renovisceral aortic branches to avoid potential catastrophic complications from crossing the aortic arch. We present our experience, comparing the right and left axillary artery.
METHODS:
Between February 2012 and January 2015, 26 patients (50% male, mean age 78.2 years) with juxtarenal aortic aneurysm (jAAA), pararenal aortic aneurysm (pAAA), or type IV thoracoabdominal aneurysm (TAAA) underwent ch-EVAR at our institution. These patients were retrospectively identified using current procedural terminology (CPT) codes for open brachioaxillary exposure. Only patients undergoing aneurysm repair were included; other indications were excluded. Access site and aortic arch complications were primary endpoints. Patient demographics, treatment indication, case planning, operative details, and clinical outcome were analyzed.
RESULTS:
Indications included asymptomatic jAAA, pAAA, or TAAA (18/26; 69.2%), type I endoleak (4/26; 15.4%), or symptomatic or ruptured aneurysm (4/26; 15.4%). The right side was utilized in 18 patients (69.2%). 14 patients required >1 sheath (56%), often through an axillary artery conduit (11/14; 78.6%). Technical success was achieved in 7/8 patients (87.5%) using left-sided access and 14/17 patients (80%) using right-sided access. Reasons for failure included inability to cannulate the right renal artery (3/25; 12%) and inability to traverse a challenging arch (1/25; 4%). One case was aborted due to bradycardia during axillary artery exposure. There was one postoperative death, which was unrelated to an access site or cerebrovascular complication. There were no cerebrovascular or upper extremity ischemic complications in any patient, regardless of access side. One complication required treatment: a left subclavian artery rupture required covered stent placement.
CONCLUSIONS:
Right axillary artery access is a safe and effective means of delivering renovascular stents during ch-EVAR. Incidence of cerebrovascular, ischemic, or other complications is low, regardless of side of access, creation of conduit, or number of sheaths used. Preoperative imaging of
the arch may not be necessary to predict complication rate or technical
success. Ability to cannulate renovascular branches may be more challenging from a right axillary approach.
Back to 2016 Annual Symposium ePosters
|
