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Abstract
PurposeThe purpose of this study was to review the risk of developing cerebrovascular complications from upper extremity access during endovascular treatment of complex aortic aneurysms.MethodsA systematic review and meta-analysis were conducted according to the PRISMA guideline. An electronic search of the public domains Medline (PubMed), Embase (Ovid), Web of Science and Cochrane Library was performed to identify studies related to the treatment of aortic aneurysms involving upper extremity access. Meta-analysis was used to compare the rate of cerebrovascular event after left, right and bilateral upper extremity access. Results are presented as relative risk (RR) and 95% confidence intervals (CIs).ResultsThirteen studies including 1276 patients with complex endovascular treatment of aortic aneurysms using upper extremity access were included in the systematic review. Left upper extremity access (UEA) was used in 1028 procedures, right access in 148 and bilateral access in 100 procedures. The rate of cerebrovascular complications for patients treated through left UEA was 1.7%, through right UEA 4% and through bilateral UEA 5%. In the meta-analysis, we included seven studies involving 645 patients treated with a left upper extremity access, 87 patients through a right and 100 patients through a bilateral upper extremity access. Patients, who underwent right-sided (RR 5.01, 95% CI 1.51–16.58, P = 0.008) or bilateral UEA (RR 4.57, 95% CI 1.23–17.04, P = 0.02), had a significantly increased risk of cerebrovascular events compared to those who had a left-sided approach.ConclusionLeft upper extremity access is associated with a significantly lower rate of cerebrovascular complications as compared to right or bilateral upper extremity access.
Highlights
The development of several complex endovascular aneurysm repair techniques has expanded the indications of endovascular aortic repair (EVAR) in more advanced aortic aneurysms, involving aneurysms with side branches or short-neck aneurysms [1–3]
Purpose The purpose of this study was to review the risk of developing cerebrovascular complications from upper extremity access during endovascular treatment of complex aortic aneurysms
We excluded two [15, 17] further studies. Both studies did present the overall stroke rate as well as the number of patients accessed from each upper limb, but it was not possible to determine how many strokes occurred after which access strategy
Summary
The development of several complex endovascular aneurysm repair techniques has expanded the indications of endovascular aortic repair (EVAR) in more advanced aortic aneurysms, involving aneurysms with side branches or short-neck aneurysms [1–3]. The choice of treatment technique depends on aneurysm extent, urgency, physician preference and availability of stent grafts at individual centers [4]. To cannulate aortic side branches, an upper extremity access is often required as adjunctive to femoral access [5]. These procedures are more challenging and time-consuming and can have more. Meertens et al.: Cerebrovascular Complications After Upper Extremity Access
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