Society For Clinical Vascular Surgery

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Lateral Axillary Exposure for Antegrade Access during Endovascular Repair of Complex Abdominal Aortic, and Thoracoabdominal Aneurysms
Jeremy Miller, B.S., Roberto Aru, M.D., Michael Bounds, M.D., Nathan Orr, M.D., David Minion, M.D., Sam Tyagi, M.D..
University of Kentucky, Lexington, KY, USA.

OBJECTIVES: Radial, brachial, and axillary approaches for device delivery for the treatment of complex Abdominal Aortic Aneurysms (AAA) and Throacoabdominal Aortic Aneurysm (TAAA) have been described, but there remains a paucity of literature on the efficacy and safety of such approaches. Our approach has been a lateral axillary exposure (LAE) with direct multiple sheath access for antegrade delivery of devices followed by primary closure of the axillary artery. The aim of this study is to describe our technique and report our results of this approach.
METHODS: This study is a retrospective review of fifty-three patients who were treated with parallel grafts for endovascular repair of complex AAA and TAAA using stent grafts. The axillary artery was exposed with a vertical axillary skin incision and retraction of the lateral border of the pectrolis major to expose the axillary artery distal to the pectoralis minor. Multiple 5 through 12-French sheaths were used to directly access the axillary artery for delivery of endovascular devices. The aortic repairs requiring LAE included: 9 cases of endoleaks from prior endovascular repair, 24 para-renal AAAs, and 20 TAAAs.
RESULTS: LAE was used to delivery 151 stents from 114 axillary sheaths into 114 arteries with 100% technical success. There were two postoperative complications: one hematoma treated conservatively with observation (1.9%), one left brachial vein DVT treated with anticoagulation (1.9%). There were no peripheral neurologic, cerebrovascular, arm ischemic complications, and no need for access related reoperation.
CONCLUSIONS: LAE is a safe and effective technique to deliver endovascular devices in the repair of complex AAA and TAAA. LAE provides antegrade access for the simultaneous delivery of multiple renovisceral devices without neurologic or ischemic complications without the use of prosthetic conduits or tunneling.


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