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Upper Extremity Access Has Worse Outcomes in F/BEVAR Using the VQI Dataset.

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Physician-modified endografts (F/BEVAR) using upper extremity (UEM) access show higher risks of death, myocardial infarction, and stroke compared to total transfemoral (TTF) access. TTF also offers shorter operative times and fewer access site complications.

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Area of Science:

  • Vascular Surgery
  • Endovascular Repair
  • Aneurysm Treatment

Background:

  • Physician-modified endografts and custom devices enable branched and fenestrated endovascular aneurysm repair (F/BEVAR) for complex aneurysms.
  • Traditionally, F/BEVAR often requires both upper and lower extremity access.
  • Emerging techniques allow simulation of upper extremity access via transfemoral approach, raising safety concerns.

Purpose of the Study:

  • To compare outcomes between total transfemoral (TTF) access and mixed upper extremity (UEM) access for F/BEVAR procedures.
  • To evaluate the risks associated with UEM access in F/BEVAR using a national database.

Main Methods:

  • Analysis of the Vascular Quality Initiative database (2014-2021) for F/BEVAR patients.
  • Stratification of patients into TTF versus any UEM access groups for target vessel stent deployment.
  • Primary outcomes: stroke, myocardial infarction (MI), perioperative death. Secondary outcomes: access site complications, operative time, fluoroscopy time, technical success.

Main Results:

  • 3,146 F/BEVAR patients: 2,309 (73.4%) TTF and 837 (26.6%) UEM.
  • UEM access was associated with a two-fold increased risk of death/MI and three-fold increased risk of stroke.
  • TTF group had significantly shorter operative and fluoroscopy times, with lower rates of access site hematoma, occlusion, and embolization.

Conclusions:

  • F/BEVAR utilizing UEM access is linked to significantly higher risks of perioperative MI, death, and stroke compared to TTF access.
  • Total transfemoral access demonstrates improved safety and efficiency for F/BEVAR procedures.