Comparison of Outcomes Between Right and Left Upper Extremity Access in Endovascular Aortic Repair for Patients with Thoracoabdominal and Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis.
Aman Goyal, Laveeza Fatima, Hritvik Jain et al.
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In 30 seconds
This systematic review and meta-analysis compared right upper extremity (RUE) with left upper extremity (LUE) access for endovascular aortic repair in patients with thoracoabdominal or abdominal aortic aneurysms. It pooled 10 observational studies involving 3994 patients. RUE access was associated with lower contrast-agent use than LUE access (SMD, -0.23; 95% CI, -0.45 to -0.02; P = 0.03). The analysis found no significant differences in stroke, 30-day mortality, technical success, access-site complications, or fluoroscopy duration.
Key findings
- Ten observational studies included 3994 patients: 1186 treated through RUE access and 2808 through LUE access.
- Contrast-agent requirement was lower with RUE access (SMD, -0.23; 95% CI, -0.45 to -0.02; P = 0.03).
- Stroke risk did not differ significantly between access groups (RR, 1.62; 95% CI, 0.81-3.22; P = 0.17).
- No significant differences were found in 30-day mortality, technical success, access-site complications, or fluoroscopy duration.
Why it matters
Upper-extremity access is used during endovascular aortic repair, and the choice of side may affect procedural considerations. This synthesis suggests that RUE access has broadly comparable measured outcomes to LUE access, with lower pooled contrast use. The findings help frame access-side decisions while highlighting that the evidence comes from observational comparisons rather than randomized allocation.
What to keep in mind
All included studies were observational, so differences between access groups may reflect factors other than access side.