Tibial access for supra-inguinal embolization in extremely obese patients

CVIR Endovascular
Jason C SmithScott T Fujimoto

Abstract

Extreme obesity is a risk factor for hemorrhagic complications of femoral access (FA). Femoral lines, hematomas, pelvic binders and coagulopathy in the trauma scenario may also add difficulty and/or risk to FA. Radial access (RA) for routine peripheral endovascular procedures has been popularized owing to decreased hemorrhagic complications, increased patient satisfaction, and decreased operator radiation dose. However, though uncommon, cerebrovascular complications from RA approach are a known risk. Relatively recently, tibial access (TA) has been used for lower extremity peripheral vascular disease interventions. The advantages of TA mirror that of RA, with few and mostly minor complications, and the risk of iatrogenic cerebral embolization is nil. We report the feasibility of TA for supra-inguinal embolization in two extremely obese patients {body mass index > 40 kg/m2} following motor vehicle accidents. Commercially available base and microcatheters were used to perform embolization of the affected lower abdominal or pelvic arteries in standard fashion via a novel trans-tibial artery approach.

References

Oct 9, 2008·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Miguel Montero-BakerDierk Scheinert
Dec 27, 2015·Journal of Vascular and Interventional Radiology : JVIR·Raghuram PoshamAaron M Fischman
Aug 26, 2016·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Craig M WalkerGeorge L Adams
Aug 27, 2017·Journal of Vascular and Interventional Radiology : JVIR·Ramsey Al-HakimJames F Benenati
Nov 19, 2017·Journal of Vascular and Interventional Radiology : JVIR·Ricardo YamadaMarcelo Guimaraes

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