Back to Annual Meeting Program

OBJECTIVES:Brachial artery access allows for remote endovascular intervention. However, controversy exists regarding the optimum choice for access - percutaneous access (PA) versus open cut-down (OCD). This study evaluates the profile associated with outcomes of PA and OCD, challenging the reported data regarding benefits of PA in regards to time to end-organ destination as well as the complication rates previously reported.
METHODS: Between 2008 and 2012 the records of 61 brachial access patients were collected for retrospective review. The method of primary access to the brachial artery was noted as open or percutaneous, and any complications and potential subsequent intervention were collected. Time for access and total procedure times, types of procedures and outcomes were collected in addition to general patient history, and all of these factors analyzed in relationship to one another.
RESULTS: There were 61 patients undergoing brachial access for either direct aortic (13), peripheral (6), brachiocephalic (3) or visceral vessel intervention (40). The incidence of pseudoaneurysms (n=9/61), was statistically different for PA (7 pt, 11%) versus OCD (2pt, 3.3%). While hematomas (n=14), nerve injury (n=4), and arterial injury (n=7) post-operatively were noted on duplex examination for 32 males and 29 females, there was no significant difference between either of the groups. The access time, from initial needle puncture (24±20 min) or scalpel incision (31±12 min), was not significantly different, nor were the complications affected by age, race, intervention performed or other medical conditions, (e.g., diabetes, renal failure, etc.). Seven patients required secondary surgery (11%), and 1 required a third operative intervention for a second open arterial repair; in all but one case of arterial rupture this was related to persistent pseudoaneurysm, including the tertiary operative repair, but there was no significance as two of seven of the patients had had OCD for initial access. There was no effect on overall procedural average times (81 vs 97 min, PA vs. OCD).
CONCLUSIONS:: Brachial access has a significantly higher complication rate than previous reported (31%), but open brachial access had a lower complication rate because of fewer pseudoaneurysms, while not appearing to affect overall procedure time. Duplex ultrasound scanning of suspected complication appears to be an effective modality to assess for complications. When complications do occur, there is an increased risk of subsequent complications.