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Case series
Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series
  1. Isaac Josh Abecassis1,
  2. Vasu Saini1,2,
  3. Timothy John Phillips3,
  4. Joshua W Osbun4,
  5. Mario Martínez-Galdámez5,
  6. Ahmed Nada1,6,
  7. Michael R Levitt7,
  8. R Webster Crowley8,
  9. Mithun G Sattur9,
  10. Alejandro M Spiotta9,
  11. Evan Luther1,
  12. Stephanie H Chen1,
  13. Joshua Burks1,
  14. Pascal Jabbour10,
  15. Ahmad Sweid10,
  16. Marios N Psychogios11,
  17. Min S Park12,
  18. Dileep R Yavagal1,2,
  19. Eric C Peterson1,
  20. Muhammad Waqas13,
  21. Rimal Hanif Dossani13,
  22. Jason M Davies13,
  23. Alex Brehm11,
  24. Gregory D Selkirk3,
  25. W Christopher Fox14,
  26. Daniel Giansante Abud15,
  27. Jorge Galvan Fernandez16,
  28. Miguel Schüller Arteaga16,
  29. Robert M Starke1
  1. 1 Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2 Neurology, University of Miami, Miami, Florida, USA
  3. 3 Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  4. 4 Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  5. 5 Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  6. 6 Neurological Surgery, Port Said University, Port Said, Egypt
  7. 7 Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
  8. 8 Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
  9. 9 Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  10. 10 Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  11. 11 Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
  12. 12 Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
  13. 13 Neurosurgery, University at Buffalo, Buffalo, New York, USA
  14. 14 Neurosurgery, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
  15. 15 Interventional Neuroradiology, Medical School of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
  16. 16 Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Castilla y León, Spain
  1. Correspondence to Dr Isaac Josh Abecassis, University of Miami Miller School of Medicine, Miami, FL 33136, USA; jabecassis{at}mac.com

Abstract

Background Radial artery access for transarterial procedures has gained recent traction in neurointerventional due to decreased patient morbidity, technical feasibility, and improved patient satisfaction. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for the neurointerventionalist, but data are limited. Our objective was to quantify the use of UETV access in neurointerventions and to measure failure and complication rates.

Methods An international multicenter retrospective review of medical records for patients undergoing UETV neurointerventions or diagnostic procedures was performed. We also present our institutional protocol for obtaining UETV and review the existing literature.

Results One hundred and thirteen patients underwent a total of 147 attempted UETV procedures at 13 centers. The most common site of entry was the right basilic vein. There were 21 repeat puncture events into the same vein following the primary diagnostic procedure for secondary interventional procedures without difficulty. There were two minor complications (1.4%) and five failures (ie, conversion to femoral vein access) (3.4%).

Conclusions UETV is safe and technically feasible for diagnostic and neurointerventional procedures. Further studies are needed to determine the benefit over alternative venous access sites and the effect on patient satisfaction.

  • angiography
  • intervention
  • technique

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Footnotes

  • Twitter @drjoshabecassis, @timbo_phillips, @Doctorgaldamez, @DrMichaelLevitt, @PascalJabbourMD, @AhmadSweidMD, @rimal_h, @wchrisfox, @neuroabud, @drschuller, @Starke_neurosurgery

  • Contributors All authors contributed to the manuscript via reviewing clinical data and approving the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RMS: research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, and by the National Institute of Health (R01NS111119-01A1) and (UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. RMS has an unrestricted research grant from Medtronic and has consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo, and Cerenovus.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review board at the University of Miami under protocol #20170149.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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