Percutaneous Carotid Access in Endovascular Aortic Arch Repair: Initial Experience.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Journal of Endovascular Therapy Pub Date : 2024-11-28 DOI:10.1177/15266028241292456
Angelos Karelis, Nivedita Mitta, Márton Berczeli, Björn Sonesson, Nuno V Dias
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Abstract

Purpose: Direct percutaneous access to the carotid artery (diPerCa) during endovascular aortic arch repair (EVAAR) can potentially present a minimally invasive access with lesser local adverse events.

Techniques: A retrospective review of consecutive EVAAR between January 2018 and January 2024, in a tertiary referral center, was performed to identify cases, in which diPerCa was used. Patients who were planned for EVAAR with no previous carotid intervention were included. A standardized technique was employed where an ultrasound-guided retrograde puncture of the carotid artery was performed with a micro-puncture set and a suture-mediated closure device (pre-closure technique). Of the 13 included patients, technical success was achieved in 12 (92.3%), with one intraoperative death unrelated to diPerCa. Major complications included one case of carotid pseudoaneurysm and one case of non-flow-limiting carotid dissection. Minor complications were unilateral recurrent laryngeal nerve palsy in one case and new-onset dizziness in one case. All carotid arteries remained patent without stenosis, with one case of non-progressing dissection noted at the conclusion of the mean follow-up of 22.5±2.4 months.

Conclusion: Direct percutaneous carotid access with suture-mediated closure devices during EVAAR is feasible with acceptable results and low incidence of clinically relevant neurological and local complications. Further studies are needed to confirm these findings and evaluate long-term outcomes.

Clinical impact: Direct percutaneous carotid access (diPerCa) during endovascular aortic arch repair (EVAAR) offers a minimally invasive alternative to retrograde access via open surgical exposure. This technique, supported by suture-based closure devices, demonstrates no stroke and low rates of local complications. Overall outcomes are promising, suggesting diPerCa as a feasible option for select patients. Further research is warranted to validate these findings and assess long-term outcomes.

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血管内主动脉弓修复术中的经皮颈动脉入路:初步经验。
目的:在血管内主动脉弓修复术(EVAAR)中直接经皮进入颈动脉(diPerCa)可能是一种局部不良事件较少的微创入路:对一家三级转诊中心在2018年1月至2024年1月期间连续进行的EVAAR进行回顾性研究,以确定使用diPerCa的病例。计划进行EVAAR且之前未进行过颈动脉介入治疗的患者被纳入其中。手术采用标准化技术,在超声引导下逆行穿刺颈动脉,使用微型穿刺器和缝合器(预闭合技术)。在纳入的 13 例患者中,12 例(92.3%)获得了技术成功,1 例术中死亡与 diPerCa 无关。主要并发症包括一例颈动脉假性动脉瘤和一例非血流限制性颈动脉夹层。轻微并发症包括一例单侧喉返神经麻痹和一例新发头晕。所有颈动脉都保持通畅,没有狭窄,在平均22.5±2.4个月的随访结束时,发现一例非进展性夹层:结论:在EVAAR手术中使用缝合闭合装置经皮直接进入颈动脉是可行的,手术效果可以接受,临床相关的神经和局部并发症发生率较低。需要进一步的研究来证实这些发现并评估长期结果:临床影响:血管内主动脉弓修复术(EVAAR)期间的直接经皮颈动脉入路(diPerCa)为开放手术暴露逆行入路提供了一种微创替代方案。该技术在缝合闭合装置的支持下,无中风发生,局部并发症发生率低。总体结果令人鼓舞,这表明 diPerCa 是特定患者的可行选择。有必要开展进一步研究,以验证这些发现并评估长期疗效。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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