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Utility and Safety of Axillary Conduits During Endovascular Repair of Thoracoabdominal Aortic Aneurysms
Jordan R. Stern, M.D., Sharif H. Ellozy, M.D., Peter H. Connolly, M.D., Andrew J. Meltzer, M.D., Darren B. Schneider, M.D..
NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.
Endovascular treatment of thoracoabdominal aortic aneurysms (TAAA) with branched and fenestrated stent grafts often requires upper extremity arterial access for antegrade delivery of bridging covered stents into the visceral arteries. Axillary, brachial and radial artery approaches have been described, but data on the safety and utility of the different approaches remains limited. We have preferentially used axillary artery conduits for upper extremity arterial access during endovascular repair of TAAA and describe our technique and report our experience herein.
25 patients were treated within an investigator-sponsored IDE clinical trial of endovascular repair of TAAAs using custom manufactured stent grafts. In 23 of these cases the axillary artery was exposed via an infraclavicular incision and an open axillary artery was utilized for antegrade delivery of bridging visceral artery stent components. In all cases a 12 French sheath was placed through the conduit for delivery of stent graft components. The left axillary artery was used in 22 of 23 cases and the right axillary artery was used in 1 patient. Proximal brachial artery access was used in 2 patients. Aneurysms treated included Crawford extent II (n=2), extent III (n=9), and extent IV (n=14). Patients have been followed up to 2 years post-procedure, with a mean follow-up of 5.7 months.
Axillary conduits were used to deliver a total of 151 stent components placed into 70 branches and 15 fenestrations with 99% technical success (one accessory renal branch could not be cannulated). There were no intra-operative complications related to the construction or use of the conduit. There were 2 post-operative complications (8.7%) potentially attributable to the conduit: One patient experienced ipsilateral hand weakness and one patient had post-operative minor stroke, which resolved by the first post-operative visit. There were no cases of arm ischemia, wound hematoma or re-operation related to the conduit.
The use of an axillary conduit during endovascular repair of complex aortic aneurysms provides safe and effective upper extremity access for delivery of visceral branches. Moreover axillary conduits facilitate delivery of 12 Fr sheaths without interrupting upper extremity perfusion and provide a shorter working distance when compared to brachial artery approaches.
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