Complications and technical success on upper limb vascular access for endovascular repair of complex abdominal and thoraco-abdominal aortic aneurysms: a systematic review and meta-analysis

Abstract

Purpose: This study aims to assess the efficacy and complications associated with upper limb catheterization during complex aneurysm endovascular surgery repair. Methods: A systematic review was conducted following PRISMA guidelines, involving a search across PubMed, Cochrane CENTRAL, and Web of Science. Primary endpoint was represented by 30-day stroke. Secondary endpoints were target vessels technical success, 30-day mortality, local access-related complications. Meta-analyses were performed using a random-effects model. Results: Sixteen observational studies encompassing 4,137 patients were included. The 30-day stroke incidence for upper limb access was 1.4% (95% CI 1.0%-1.8%), slightly higher than lower limb, despite not statistically significant. Mortality was at 1.3% (95% CI 0.7%-1.9%), and local access-related complications occurred in 3.2% (95% CI 1.9%-4.4%). Technical success in target vessel catheterization was 99.2% (95% CI 98.4%-100.0%). Conclusion: This systematic review and meta-analysis demonstrate the safety and efficacy of upper limb access for f/b-EVAR, with low stroke risk, mortality rates, and minimal local complications. The findings support the use of upper limb access, particularly in bailout situations when femoral access fails, contributing valuable insights for clinical decision-making.