Stonier TW, Patel K, Bhrugubanda V, Choong AMTL. Carotid Access for Endovascular Repair of Aortic Pathology: A Systematic Review.
Ann Vasc Surg 2018;
49:206-218. [PMID:
29428538 DOI:
10.1016/j.avsg.2018.01.060]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/06/2017] [Accepted: 01/29/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND
Endovascular repair is now preferred to open access for the management of aortic diseases. This is typically performed via the femoral artery; however, not all patients are eligible for this. This systematic review summarizes the current evidence for utilizing the carotid artery as an alternative access route.
METHODS
A systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using 4 electronic databases.
RESULTS
The search found 11 case reports representing 12 patients eligible for analysis (mean age 64.5 years). This included 3 thoracic aneurysms, 3 abdominal aneurysms, 4 penetrating ulcers, 1 endoleak, and 1 pseudoaneurysm. An open procedure was contraindicated in 83% (10/12) due to the poor physiological fitness of the patient. In 75% (9/12) of cases, traditional endovascular access was contraindicated by severe iliac disease. The remainder were contraindicated because of an existing ligated aortic stump (1/12, 8.3%) or technical difficulty with graft deployment via the femoral artery (2/12, 16.7%). There was 1 death, with the 30-day mortality 8.3%. The same patient suffered the only spinal ischemia before death (8.3%). There were no cases of stroke (0%), with one case of transient ischemic attack (8.3%).
CONCLUSIONS
Although there is a relative paucity of literature, this study demonstrates when traditional endovascular access is impossible and an open procedure contraindicated, carotid artery access for endovascular repair of aortic pathology is a viable alternative with good 30-day survival and low rates of neurological sequelae.
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