TY - JOUR
T1 - Vascular Access Challenges in Thoracic Endovascular Aortic Repair
T2 - A Literature Review
AU - Mandigers, Tim J
AU - Lomazzi, Chiara
AU - Domanin, Maurizio
AU - Pirrelli, Stefano
AU - Piffaretti, Gabriele
AU - van Herwaarden, Joost A
AU - Trimarchi, Santi
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/8
Y1 - 2023/8
N2 - BACKGROUND: This review aims to comprehensively summarize access challenges in thoracic endovascular aortic repair (TEVAR) by describing vascular access routes, associated risks, outcomes, and complications.METHODS: A literature search was conducted utilizing the PubMed (Medline), Scopus, and Web of Science databases. Qualitative and quantitative data from selected studies are extracted and discussed according to available standards for narrative reviews.RESULTS: In total, there were 109 eligible studies based on predefined inclusion- and exclusion criteria. There were 39 original articles or reviews and 57 case series or case reports. This article summarizes the evidence from these studies and discusses traditional retrograde access routes and techniques for TEVAR via a femoral or iliac route, with or without the use of conduits. Next, alternative antegrade access routes and techniques via a brachial, axillary, carotid, ascending aorta, transapical, transcaval, or another route are discussed. Vascular access complications are presented with specific attention to the importance of gender and alternative antegrade access routes.CONCLUSIONS: Multiple access routes and techniques are currently available to overcome access challenges associated with TEVAR, based on low grade evidence from heterogeneous studies. Future research that compares different access routes and techniques might help in the development of a tailored access protocol for specific patients with challenging TEVAR access.
AB - BACKGROUND: This review aims to comprehensively summarize access challenges in thoracic endovascular aortic repair (TEVAR) by describing vascular access routes, associated risks, outcomes, and complications.METHODS: A literature search was conducted utilizing the PubMed (Medline), Scopus, and Web of Science databases. Qualitative and quantitative data from selected studies are extracted and discussed according to available standards for narrative reviews.RESULTS: In total, there were 109 eligible studies based on predefined inclusion- and exclusion criteria. There were 39 original articles or reviews and 57 case series or case reports. This article summarizes the evidence from these studies and discusses traditional retrograde access routes and techniques for TEVAR via a femoral or iliac route, with or without the use of conduits. Next, alternative antegrade access routes and techniques via a brachial, axillary, carotid, ascending aorta, transapical, transcaval, or another route are discussed. Vascular access complications are presented with specific attention to the importance of gender and alternative antegrade access routes.CONCLUSIONS: Multiple access routes and techniques are currently available to overcome access challenges associated with TEVAR, based on low grade evidence from heterogeneous studies. Future research that compares different access routes and techniques might help in the development of a tailored access protocol for specific patients with challenging TEVAR access.
KW - Aorta, Thoracic/diagnostic imaging
KW - Aorta/surgery
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Endovascular Aneurysm Repair
KW - Endovascular Procedures/adverse effects
KW - Humans
KW - Retrospective Studies
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85142531486&partnerID=8YFLogxK
U2 - 10.1016/j.avsg.2022.10.001
DO - 10.1016/j.avsg.2022.10.001
M3 - Review article
C2 - 37534575
SN - 0890-5096
VL - 94
SP - 22
EP - 31
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -