Open Axillary Access for complex endovascular aortic repair; a UK tertiary centre experience

Nandhra. S, Nesbitt. C, Priona. G, Williams. R, McCaslin. J
Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne

Complex endovascular aortic repair is frequently performed using concurrent axillary artery access; this can offer a favourable trajectory for the cannulation of the caudally-orientated visceral vessels. However, associated cerebrovascular complications are reported to be between 2 and 15%. Furthermore, it is hypothesised to be greater with right-sided axillary access due arch manipulation across the origins of the cerebral vessels. The experiences of a UK tertiary centre were reviewed to assess the morbidity associated with axillary access. 

A retrospective analysis was performed to identify cases of open axillary exposure for complex aortic endovascular repair. Right-sided access was preferentially utilised unless there was arch disease or the left was unavailable. The primary endpoint was clinical cerebrovascular complication and the secondary endpoint was local access complications. 

A total of 177 complex endovascular aortic repairs performed between 2009 and 2018 were reviewed. 

63 underwent open axillary exposure (44 male:19 female), with a mean age at intervention of 72.4(8.35 s.d.) years. Right-sided access was performed in 46 cases. 

There were no cerebrovascular complications. 

5 local complications occurred. Two incidences of haematoma requiring surgical intervention (1 right, 1 left). 2 cases of limited right sided dissection and 1 dissection causing asymptomatic occlusion. 

Successful visceral cannulation was achieved in all cases. 

This case-series demonstrates that open axillary access is safe. In particular, right-sided access does not result in increased clinical cerebrovascular complications. Furthermore, local access complications are minimal. 

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