Outcomes and strategies for utilization of brachial access and preloaded systems during fenestrated and branched endovascular aneurysm repair

The management of complex aortic aneurysms has evolved significantly with the advent of endovascular aortic repair. Fenestrated and branched endovascular aneurysm repair (FBEVAR) has become an alternative to open surgical repair for patients with complex aortic aneurysms. The decision-making process involves evaluating various anatomic and technical factors, including arterial access sites. Upper extremity access, specifically through the brachial artery, is a recognized and safe technique, particularly in challenging vascular anatomy. Additionally, preloaded delivery systems with wires and catheters have become integral to FBEVAR. This review examines outcomes and techniques associated with brachial access and preloaded systems during FBEVAR. An extensive analysis of the literature explores the benefits and risks of upper extremity access. The review also evaluates the use of preloaded wires and catheters, discussing various premanufactured devices and their applications in FBEVAR. Upper extremity access is a valuable tool in FBEVAR, particularly in cases with challenging anatomy. Brachial and axillary access are both feasible with comparable outcomes, though access site and cerebrovascular complications are not negligible, emphasizing the importance of tailored patient selection. Preloaded systems offer efficient target vessel cannulation, minimizing graft manipulation and improving procedural ease. Brachial access and preloaded systems contribute to the success of FBEVARfor complex aortic aneurysms. While complications associated with upper extremity access exist, careful patient selection, procedural expertise, and advancements in device design have mitigated risks. The advancements in FBEVAR demonstrate the adaptability and efficacy of these techniques for individualized approaches to complex aortic aneurysm treatment.