Tibial access for supra-inguinal embolization in extremely obese patients

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Trauma Management

Background:

• Extreme obesity increases hemorrhagic risks with femoral access (FA).
• Radial access (RA) reduces complications but carries cerebrovascular risks.
• Tibial access (TA) is emerging for lower extremity interventions with minimal complications.

Purpose of the Study:

• To assess the feasibility of trans-tibial access (TA) for supra-inguinal embolization in extremely obese patients.
• To evaluate TA as a safer alternative to FA and RA in specific trauma scenarios.

Main Methods:

• Utilized commercially available catheters for embolization.
• Performed embolization of lower abdominal or pelvic arteries via a novel trans-tibial artery approach.
• Applied the technique in two extremely obese patients (BMI > 40 kg/m²) post-motor vehicle accidents.

Main Results:

• Successfully performed supra-inguinal embolization using the trans-tibial artery approach in both patients.
• Demonstrated the feasibility of TA for complex embolization in a high-risk patient group.
• Highlighted the nil risk of iatrogenic cerebral embolization with TA.

Conclusions:

• Trans-tibial access is a feasible and potentially safer approach for supra-inguinal embolization in extremely obese trauma patients.
• TA circumvents the hemorrhagic risks of FA and cerebrovascular risks of RA.
• This novel approach expands endovascular treatment options for challenging patient populations.