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Vascular Closure Devices For Axillary Artery Access: A Systematic Review and Meta-Analysis.

Alex Koziarz¹, Sean A Kennedy², Ghassan Awad El-Karim²

¹Department of Radiology, McMaster University, Hamilton, ON, Canada.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists

|January 10, 2023

Summary

This summary is machine-generated.

Vascular closure devices (VCDs) in the axillary artery show an 85% technical success rate. Larger sheath sizes are linked to lower success and increased complications, highlighting the need for careful consideration in endovascular interventions.

Keywords:

axillary artery interventional radiology vascular closure device

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Area of Science:

Cardiovascular Interventions
Vascular Surgery
Medical Devices

Background:

The common femoral artery is a standard access site for endovascular interventions.
The increasing demand for larger sheath sizes necessitates exploration of alternative arterial access sites.
The axillary artery is an emerging alternative access site for complex endovascular procedures.

Approach:

A systematic review and meta-analysis of observational studies (MEDLINE, Embase) up to October 2021.
Included 20 studies with 915 axillary artery access sites.
Analyzed technical success, hematoma, dissection, pseudoaneurysm, infection, and neurological complications, with logistic regression for sheath size influence.

Key Points:

Pooled technical success rate for VCDs in the axillary artery was 84.8%.
Pooled complication rates: hematoma 7.9%, dissection 3.1%, pseudoaneurysm 2.7%, infection <1%, local neurological complications 2.7%.
Increased sheath size was significantly associated with lower technical success (OR 0.87 per 1 Fr increase) and higher access-site complications (aOR 1.21 per 1 Fr increase).

Conclusions:

Off-label use of VCDs in the axillary artery is feasible with a high technical success rate.
Sheath size is a critical factor influencing both technical success and complication rates in axillary artery access.
This meta-analysis provides valuable data for clinicians regarding the safety and efficacy of axillary artery access with VCDs.