Percutaneous radial access is safe and effective for subclavian branch treatment during zone 2 endovascular aortic repair with thoracic branch endoprosthesis.

The thoracic branch endoprosthesis (TBE, W. L. Gore & Associates) provides an off-the-shelf endovascular solution for zone 2 aortic pathology that maintains perfusion to the arm. This study evaluates safety and efficacy of percutaneous radial access for subclavian branch treatment during TBE repair. A single-institution retrospective review of consecutive patients who underwent zone 2 aortic repair with TBE between 2022 and 2024 was performed. Treatment indications included acute complicated aortic dissection, aortic dissection with aneurysmal degeneration, penetrating aortic ulcer, blunt thoracic aortic injury, and de novo aneurysmal disease. Sixty-three consecutive patients (66.7% male; mean age, 61.0 ± 16.5 years) underwent zone 2 repair with a TBE device, 29 (46.0%) for aneurysmal disease, 15 (23.8%) for blunt thoracic aortic injury, 17 (27.0%) for dissection, and 2 (3.2%) for penetrating aortic ulcer. Twenty-one (33.3%) were urgent or emergent cases performed within 24 hours of presentation. Side branch treatment was performed through percutaneous left radial access in 60 patients (95.2%). Radial access was technically successful in 100% of attempts without the need for more proximal percutaneous or open upper extremity access. One (1.7%) asymptomatic radial artery occlusion was detected postoperatively, and did not require intervention. Postoperative imaging was obtained before discharge in 58 patients (92.1%), demonstrating 100% subclavian side branch patency. These results demonstrate that left radial access is safe and effective for subclavian branch treatment during thoracic branch endoprosthesis for management of zone 2 aortic pathology.