Study weighs up total transfemoral and upper extremity approaches for F/BEVAR

Gustavo Oderich, MD

In a prospective, non-randomized study, researchers found that a total transfemoral approach was associated with lower rates of cerebrovascular events and improved outcomes compared to an upper extremity approach during fenestrated/branched endovascular aneurysm repair (F/BEVAR).

Thomas Mesnard, MD, research fellow at the University of Texas Health Science Center at Houston, is due to share this finding with the VAM audience this morning (11:45–11:52 a.m.) during Plenary Session 4, which takes place in Potomac A/B.

The authors detail in their abstract that this study was conducted over the course of nine years, from 2013–2022, and included 541 patients (70% male; mean age, 74±8 years) treated with F/BEV­AR. They specify that an upper extremity approach was used in 366 (68%) patients and transfemoral access in 177 (33%) patients.

Mesnard will report that the use of a transfemoral approach was associated with lower fluoroscopy time (p=0.001), lower operative time (p<0.001), similar cumulative air kerma (p=0.2), and similar technical success (p=0.96) as compared to an upper extremity approach. Mortality occurred in 1% of all patients, with no significant difference between groups (p=0.67).

Furthermore, he will share that patients treated by an upper extremity approach had significantly higher rates of major adverse events (18% vs. 8%, p=0.006) and more cerebrovascular events (3% vs. 0%, p=0.035).

Mesnard will present these findings on behalf of Gustavo S. Oderich, MD, professor of surgery and chair of vascular and endovascular surgery at the University of Texas Health Science Center at Houston, and colleagues.

Speaking to VS@VAM ahead of the presentation, Oderich comment­ed on what procedures in this space might look like in the future: “Transfemoral access allowed us to reduce the risk of stroke and complications. This has been possible with the development of steerable sheaths. It is likely that, with the introduction of smaller-profile stents and better sheaths, the procedure will be simplified even further.”


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