Upper extremity transvenous access in neurointerventional procedures: Insights from the largest single-center experience

Background

The transfemoral approach has traditionally been the primary access site for catheter-guided venography. Recently, upper extremity transvenous access (UETV) has emerged as a promising alternative for neurointerventional procedures, offering potential advantages such as reduced bleeding risk, improved ergonomics, faster recovery, shorter procedure and fluoroscopy times, and a lower likelihood of inadvertent arterial puncture. This study reports on a single-center experience of UETV for neurointerventional venous therapy.

Methods

A total of 158 diagnostic venograms and venous interventions were performed by a single operator between 2020 and 2024 at a single center, with primary intent to use the upper extremity veins for venous access. Data on patient demographics, procedural details, radiographic findings, and outcomes were collected and analyzed.

Results

Out of 158 procedures, successful upper extremity catheterization was achieved in 155 cases (98.1%), with 149 (94.3%) completed successfully. Conversion to a femoral approach was necessary in 3 cases (1.9%), all of which were completed successfully. Six interventions (3.8%) were aborted due to challenges in navigating the intracranial veins and venous sinuses that were unrelated to peripheral access. Minor complications occurred in 8 patients (5.1%); no major complications were observed.

Conclusions

This single-center study demonstrates the feasibility and safety of upper extremity-only transvenous access for neurointerventional procedures in the management of complex cerebrovascular diseases. The cephalic and basilic veins of the antecubital fossa veins are recommended as primary access sites. These findings represent the largest case series to date using an upper extremity-first transvenous approach for neurointerventional therapy.