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Cited by 8Vascular Procedures and ComplicationsAortic Disease and Treatment ApproachesCentral Venous Catheters and Hemodialysis

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Multicentre International Registry of Open Surgical Versus Percutaneous Upper Extremity Access During Endovascular Aortic Procedures

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Bertoglio, Luca, Oderich, Gustavo, Melloni, Andrea, Gargiulo, Mauro, Kölbel, Tilo, Adam, Donald J., Di Marzo, Luca, Piffaretti, Gabriele, Agrusa, Christopher J., Van den Eynde, Wouter, Howard, Dominic PJ., Rio, Javier, Fazzini, Stefano, Dias, Nuno V., Ronchey, Sonia, Parlani, Gianbattista, D’Oria, Mario, Tenorio, Emanuel R., Gallitto, Enrico, Panuccio, Giuseppe, Claridge, Martin, Mansour, Wassim, Fontana, Federico, Chu, Rosa Aurora, Verbist, Jürgen, Builyte, Inga U., Ligero, Jose M., Ippoliti, Arnaldo, Sonesson, Björn, Locca, Maria Lucia, Lenti, Massimo, Lepidi, Sandro, Chiesa, Roberto·2023·European Journal of Vascular and Endovascular Surgery
DOI 10.1016/j.ejvs.2023.01.046
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Abstract

OBJECTIVE: To investigate access failure (AF) and stroke rates of aortic procedures performed with upper extremity access (UEA), and compare results of open surgical vs. percutaneous UEA techniques with closure devices. METHODS: A physician initiated, multicentre, ambispective, observational registry (SUPERAXA - NCT04589962) was carried out of patients undergoing aortic procedures requiring UEA, including transcatheter aortic valve replacement, aortic arch, and thoraco-abdominal aortic endovascular repair, pararenal parallel grafts, renovisceral and iliac vessel repair. Only vascular procedures performed with an open surgical or percutaneous (with a suture mediated vessel closure device) UEA were analysed. Risk factors and endpoints were classified according to the Society for Vascular Surgery and VARC-3 (Valve Academic Research Consortium) reporting standards. A logistic regression model was used to identify AF and stroke risk predictors, and propensity matching was employed to compare the UEA closure techniques. RESULTS: Sixteen centres registered 1 098 patients (806 men [73.4%]; median age 74 years, interquartile range 69 - 79 years) undergoing vascular procedures using open surgical (76%) or percutaneous (24%) UEA. Overall AF and stroke rates were 6.8% and 3.0%, respectively. Independent predictors of AF by multivariable analysis included pacemaker ipsilateral to the access (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.2 - 12.1; p = .026), branched and fenestrated procedure (OR 3.4, 95% CI 1.2 - 9.6; p = .019) and introducer internal diameter ≥ 14 F (OR 6.6, 95% CI 2.1 - 20.7; p = .001). Stroke was associated with female sex (OR 3.4, 95% CI 1.3 - 9.0; p = .013), vessel diameter > 7 mm (OR 3.9, 95% CI 1.1 - 13.8; p = .037), and aortic arch procedure (OR 7.3, 95% CI 1.7 - 31.1; p = .007). After 1:1 propensity matching, there was no difference between open surgical and percutaneous cohorts. However, a statistically significantly higher number of adjunctive endovascular procedures was recorded in the percutaneous cohort (p < .001). CONCLUSION: AF and stroke rates during complex aortic procedures employing UEA are non-negligible. Therefore, selective use of UEA is warranted. Percutaneous access with vessel closure devices is associated with similar complication rates, but more adjunctive endovascular procedures are required to avoid surgical exposure.

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Metadata

Authors
Bertoglio, L., Oderich, G., Melloni, A., Gargiulo, M., Kölbel, T., Adam, D. J., Di Marzo, L., Piffaretti, G., Agrusa, C. J., Van den Eynde, W., Howard, D. P., Rio, J., Fazzini, S., Dias, N. V., Ronchey, S., Parlani, G., D’Oria, M., Tenorio, E. R., Gallitto, E., Panuccio, G., Claridge, M., Mansour, W., Fontana, F., Chu, R. A., Verbist, J., Builyte, I. U., Ligero, J. M., Ippoliti, A., Sonesson, B., Locca, M. L., Lenti, M., Lepidi, S., & Chiesa, R.
Affiliations
  • Vita-Salute San Raffaele University (IT)
  • The University of Texas Health Science Center at Houston (US)
  • IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
  • Universität Hamburg (DE)
  • University Hospitals Birmingham NHS Foundation Trust (GB)
  • Policlinico Umberto I (IT)
  • University of Insubria (IT)
  • NewYork–Presbyterian Hospital (US)
Corresponding author
Bertoglio, Luca
ORCID
Venue
European Journal of Vascular and Endovascular Surgery
Publisher
Elsevier BV
Published
2023-05
Volume
65
Issue
5
Pages
729-737
ISSN
1078-5884 (ISSN-L)
DOI
10.1016/j.ejvs.2023.01.046
OpenAlex
W4319159417
Cited by
8
References
0
Citations by year
2025: 2 · 2024: 2 · 2023: 4
FWCI
1.48
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Vascular and Endovascular Surgery (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion, other-oa)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by-nc-nd)
  • Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
  • IrInSubria (University of Insubria) (submittedVersion)
Funders
Abbott Vascular
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Central Venous Catheters and Hemodialysis
Keywords
upper extremity access, access failure, stroke, transcatheter aortic valve implantation, aortic arch surgery, suture-mediated closure device, percutaneous access, cardiac pacemaker
MeSH terms
Aged, Blood Vessel Prosthesis, Female, Humans, Male, Registries, Retrospective Studies, Risk Factors, Treatment Outcome, Aortic Aneurysm, Thoracic, Blood Vessel Prosthesis Implantation, Stroke, Upper Extremity, Endovascular Procedures

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