Choong, Andrew M. T. L. (2020) An investigation into unusual access sites for arterial endovascular interventions. PhD thesis, University of Warwick.

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Abstract

The endovascular revolution has transformed clinical practice with significant benefits to patients, in particular, as minimally invasive treatment options for those who would have previously been deemed inoperable by conventional ‘open’ surgical techniques. However, it is impossible to perform arterial endovascular interventions without accessing the arterial system first. Despite close to 100 years of technological and procedural improvement, the femoral artery remains the gold standard arterial access site. In those patients where femoral arterial access is contraindicated, alternative access sites have been described. The majority of these access sites are standard alternatives and are already used in routine clinical practice. However, other arterial access sites are more unusual, and their use is potentially more harmful to patients than standard access. As a vascular, endovascular and aortic surgeon, I have a varied practice that ranges from traditional open surgery to arterial endovascular interventions, creating alternative vascular access for other specialties who may require it and also repairing the complications arising from vascular access as well. I remain keen to maximise the benefits of endovascular surgery for all my patients, even if femoral arterial access is contraindicated. This led me to investigate unusual arterial access sites for arterial endovascular interventions. Some of the early descriptions in the literature of unusual access sites for arterial endovascular interventions were not just radical but potentially significantly harmful to patients. A lack of pooled contemporary evidence was sorely lacking, and I embarked on this body of work to fill that evidence gap. My ultimate aim was to educate myself and my colleagues who may also require unusual access sites in their clinical practice, whilst keeping patient safety at the forefront and of paramount importance.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RC Internal medicine R Medicine > RD Surgery
Library of Congress Subject Headings (LCSH):	Blood-vessels -- Endoscopic surgery, Femoral artery -- Endoscopic surgery, Endoscopic surgery, Blood-vessels -- Cutdown
Official Date:	February 2020
Dates:	Date Event February 2020 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Randeva, Harpal S. ; Srirajaskanthan, Rajaventhan
Sponsors:	National university of Singapore
Format of File:	pdf
Extent:	various pagings : illustrations
Language:	eng

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