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Percutaneous Radial Access Is Safe And Effective For Subclavian Branch Treatment During Zone 2 Endovascular Aortic Repair With Thoracic Branched Endoprosthesis
Matthew Schneck, MD, Kathryn L. Dilosa, Steven Maximus, MD.
University of California Davis, Sacramento, CA, USA.
OBJECTIVES: The thoracic branched endoprosthesis (TBE, WL Gore, Flagstaff AZ) provides an off the shelf endovascular solution for zone 2 aortic pathology that maintains in-line perfusion to the arm. This study evaluates safety and efficacy of percutaneous radial access for subclavian branch treatment during TBE repair.
METHODS: A single institution retrospective review of consecutive patients who underwent on-label zone 2 aortic repair with TBE between 2022 and 2024 was performed. Treatment indications included aortic dissection, aortic dissection with aneurysmal degeneration, penetrating aortic ulcer (PAU), blunt thoracic aortic injury (BTAI), and aneurysmal disease. Primary outcomes evaluated were technical success of percutaneous radial access, access complication rate, and subclavian side branch patency.
RESULTS: 63 consecutive patients (66.7% male, mean age 61 years ± 16.5) underwent zone 2 repair with a TBE, 29 (46.0%) for aneurysmal disease in either definitive or staged repair, 15 (23.8%) for BTAI, 17 (27.0%) for dissection, and 2 (3.2%) for PAU. Of these, 21 (33.3%) were emergent cases performed within 24 hours of presentation. Side branch treatment was performed through percutaneous left radial access in 60 patients (95.2%). 3 patients required primary brachial access due to either concomitant upper extremity trauma or prior radial harvest for coronary bypass. Radial access was technically successful in 100% of attempts without need for more proximal percutaneous or open upper extremity access (Table 1). One (1.7%) asymptomatic radial artery occlusion was detected postoperatively that did not require intervention. There were no other reported radial artery access complications. Post-operative imaging was obtained prior to discharge in 58 (92.1%) patients demonstrating 100% subclavian side-branch patency. Late term follow-up imaging (>30 days) was obtained in 33 patients (52.4%) also demonstrating 100% side branch patency.
CONCLUSIONS: Left radial access is safe and effective for subclavian branch treatment with thoracic branched endoprosthesis in management of zone 2 aortic pathology.
Table 1: Percutaneous Radial Access Outcomes| Pathology | Percutaneous Radial Access Attempted | Technical Success of Radial Access | Radial Access Complications | Left Subclavian Side Branch Patency |
| Aneurysm / Pseudoaneurysm (N=29) | 28 (96.5%) | 28 (100%) | 1 - asymptomatic thrombosis | 27 (100%) |
| Blunt Thoracic Aortic Injury (N=15) | 13 (86.7%) | 13 (100%) | 0 | 13 (100%) |
| Aortic Dissection (N=17) | 17 (100%) | 17 (100%) | 0 | 17 (100%) |
| Penetrating Aortic Ulcer (N=2) | 2 (100%) | 2 (100%) | 0 | 2 (100%) |
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