Percutaneous Brachial Access Associated With Increased Incidence Of Complications Compared To Open Exposure For Peripheral Vascular Interventions In Contemporary Series
Charles DeCarlo, MD, Christopher Latz, MD, Laura T. Boitano, MD, MPH, Anna A. Pendleton, MD, Jahan Mohebali, MD, Mark F. Conrad, MD, MMSc, Matthew J. Eagleton, MD, Samuel I. Schwartz, MD.
Massachusetts General Hospital, Boston, MA, USA.
OBJECTIVES: While percutaneous brachial access is being used more commonly for peripheral vascular interventions (PVI), prior studies have suggested open brachial artery exposure for access is associated with fewer complications than percutaneous access. This study sought to determine the incidence of complications for each access method and identify predictors of access site complications after brachial access.
METHODS: The Vascular Quality Initiative national database was queried for all patients who underwent PVI with brachial artery access from the years 2016-2019. Procedures with simultaneous thrombolysis or open procedures were excluded. The primary outcome was any perioperative brachial artery access complications; multivariable logistic regression was used to identify associated predictors.
RESULTS: There were 1,400 procedures performed on 1,242 patients; 189 procedures (13.5%) utilized open exposure. Mean age was 67.3±9.5 and 55.7% of procedures were on males. There were no significant demographic differences between the open and percutaneous groups. Open exposure procedures were more likely to utilize sheaths larger than 5 french (Fr) (79.4% vs 59.0%; p-value<0.001) and treat more arteries (2.0±1.8 vs 1.7±0.9; p-value<0.001), but less likely to utilized multiple access sites (8.5% vs 20.1%; p-value<0.001). Access complications occurred in 7.5% of percutaneous procedures and 1.6% of open exposures (p=0.003). Specific complications are displayed in Table I. Percutaneous access was an independent predictor of brachial access complications (OR 5.9, 95%CI: 1.8-19.1; p-value=0.003). Other predictors include female sex (OR 2.2, 95%CI: 1.4-3.5; p-value<0.001), CHF (OR 2.0, 95%CI: 1.3-3.3;p-value=0.004), and increasing sheath size (OR 1.4 per Fr, 95%CI: 1.04-1.80; p-value=0.026); diabetes was protective (OR 0.5, 95%CI: 0.3-0.8; p-value=0.006)
CONCLUSIONS: Open exposure may be advantageous over percutaneous access in terms of preventing complications after brachial access. Percutaneous access should be used cautiously in patients with other risk factors such as women, patients with a history of CHF, non-diabetics, and interventions where larger sheaths are required.
| Table I: Brachial Access Complications | |||||
| Percutaneous (N=1,211) | Open Exposure (N=189) | ||||
| n | % | n | % | P-Value | |
| Any Access Complication | 91 | 7.5% | 3 | 1.6% | 0.003 |
| Operative Access Complication | 37 | 3.1% | 3 | 1.6% | 0.260 |
| Hematoma | 71 | 5.9% | 1 | 0.5% | 0.002 |
| Hematoma Requiring Intervention | 17 | 1.4% | 1 | 0.5% | 0.321 |
| Thrombosis | 13 | 1.1% | 2 | 1.1% | 0.985 |
| Thrombosis Requiring Intervention | 13 | 1.1% | 2 | 1.1% | 0.985 |
| Pseudoaneurysm | 19 | 1.6% | 0 | 0% | 0.083 |
| Operative pseudoaneurysm | 12 | 1.0% | 0 | 0% | 0.169 |
| Infection | 0 | 0% | 0 | 0% | .999 |
| Arteriovenous Fistula | 0 | 0% | 0 | 0% | .999 |
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