RS14 - Total Transfemoral Approach Is Associated with Lower Rates of Cerebrovascular Events and Improved Outcomes Compared to Upper Extremity Approach During Fenestrated-branch Endovascular Aortic Repair

Thursday, June 15, 2023

11:45 AM – 11:52 AM ET

Presenting Author only(s)

TM

Thomas Mesnard, MD (he/him/his)

Research Fellow
University of Texas Health Science Center at Houston
Houston, Texas

Co-Author(s)

AV

Andrea Vacirca, MD, PhD

Research Fellow
University of Texas Health Science Center at Houston
Houston, Texas
TS

Titia Sulzer, MS

Master Student
Erasmus University Medical Center
Rotterdam, Zuid-Holland, Netherlands
Aidin Baghbani-Oskouei, MD (he/him/his)

Research Fellow
University of Texas Health Science Center at Houston
Houston, Texas
SS

Safa Savadi

Research Fellow
University of Texas Health Science Center at Houston
Houston, Texas
YH

Ying Huang

University of Texas Health Science Center at Houston
Houston, Texas
ET

Emanuel Tenorio
Bernardo C. Mendes, MD

Associate Professor of Surgery
Division of Vascular and Endovascular Surgery, Mayo Clinic
Rochester, Minnesota
AM

Aleem K. Mirza

Assistant Professor of Surgery
University of Texas Health Science Center
Houston, Texas
NS

Naveed U. Saqib

Associate Professor
University of Texas Health Science Center at Houston
Houston, Texas

Submitting Author only(s)

Gustavo S. Oderich, MD

Professor of Surgery and Chair of Vascular and Endovascular Surgery
University of Texas Health Science Center at Houston
Houston, Texas

Objectives: Upper extremity (UE) access has been widely used during fenestrated-branched endovascular aortic repair (FB-EVAR), but potentially increases the risk of cerebrovascular events. Steerable sheaths have allowed more liberal use of a total transfemoral (TF) approach (Figure 1), but this technique may increase technical difficulty, operative time and lower extremity ischemia. The aim of this study was to compare procedural metrics and early outcomes of FB-EVAR for complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA) using either UE or TF approach for vessel incorporation.

Methods: Patients enrolled in a prospective, non-randomized study to investigate FB-EVAR were analyzed (2013-2022). End-points included procedural metrics, technical success, 30-day mortality, major adverse events (MAEs) and rates of cerebrovascular events in patients who had UE or TF approach for renal-mesenteric vessel incorporation.

Results: There were 541 patients (70% male; mean age 74±8 years-old) treated by FB-EVAR using UE approach in 366 (68%) patients and TF access in 177 (33%) patients. 2107 renal-mesenteric arteries were incorporated with a mean of 3.9±0.5 vessels per patient. TF approach was used in 8% of patients between 2013-2018 and progressively increased to 31% between 2018-2020 and 96% between 2020-2022 (p <.05). Both groups had similar characteristics, except for significantly (P <.05) less ASA > 3 (51% v 75%, less CAAAs (24% v 37%) and more TAAAs (76% v 63%) among patients who had UE approach as compared to TF approach, respectively. Use of TF approach was associated with lower fluoroscopy time (P=.001), lower operative time (P <.001), similar Cumulative Air Kerma (P=.20), and similar technical success (P=.96) as compared to UE approach (Table 1). Mortality was 1% for all patients, with no difference between groups (P=.67). Patients treated by UE approach had significantly higher rates of MAEs (18% v 8%, P=.006) and more cerebrovascular events (3% v 0%, P=.035). Access complications occurred in 2% of patients, mostly related to femoral access sites, with no difference between groups (P>.99).

Conclusions: Total transfemoral approach has been increasingly used during FB-EVAR and was associated with lower rates of MAEs and cerebrovascular events. There was no difference in technical success between the two approaches, but TF approach was associated with shorter operative time.