Distal Radial Access for Thoracic Branch Endoprosthesis Deployment: Two Cases of Successful TEVAR with Left Subclavian Artery Revascularization

Background and Clinical Significance: Thoracic endovascular aortic repair (TEVAR) involving zone 2 of the aortic arch frequently necessitates left subclavian artery (LSA) revascularization to reduce the risk of neurologic and ischemic complications. If endovascular methods are employed, conventional upper extremity access via the brachial or axillary artery often requires surgical cutdown and carries meaningful access-site morbidity. Distal radial (snuffbox) access offers a less invasive percutaneous alternative, yet its use for thoracic branch endoprosthesis (TBE) deployment has only rarely been reported; Case Presentation: We present two patients who underwent successful zone 2 TEVAR with TBE implantation and LSA revascularization using a femoral-to-distal radial through-and-through wire technique. In both cases, the branch component was deployed via the distal radial artery with excellent angiographic results and preserved antegrade flow to the LSA. Neither patient experienced access-related complications; Conclusions: These cases demonstrate the technical feasibility and safety of distal radial access for TBE deployment in zone 2 TEVAR. This approach offers a less invasive alternative to conventional upper extremity access, potentially reducing vascular complications and facilitating earlier recovery.