Nicholas J Madden1, Keith D Calligaro2, Hong Zheng2, Douglas A Troutman2, Matthew J Dougherty2. 1. Department of Surgery, Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA. Electronic address: nicholasma@pcom.edu. 2. Department of Surgery, Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA.
Abstract
BACKGROUND: A percutaneous brachial artery (BA) approach is a suitable or even favorable alternative to femoral artery access when performing certain endovascular interventions. However, this approach may have a higher complication rate compared to femoral artery access. We analyzed our results using percutaneous BA approach for noncardiac endovascular interventions. METHODS: Between January 1, 2003 and December 31, 2017, BA access was used in 157 cases performed on 136 patients. The procedures included 102 (65%) therapeutic interventions and 55 (35%) diagnostic studies. The vessels studied or treated included lower extremity arteries (48), the aorta and iliac arteries (45), mesenteric arteries (45), failing arterial revascularizations (24), renal arteries (9), subclavian arteries (8), carotid arteries (2), and visceral aneurysms (2), or in conjunction with endovascular aneurysm repair (EVAR), fenestrated EVAR, or thoracic EVAR (8). More than 1 vessel was studied or treated in 34 cases. Sheath sizes included 5F in 38 (24%) cases, 6F in 93 (59%) cases, and 7F in 26 (17%) cases. Percutaneous puncture was utilized in 142 (90.4%) cases and planned surgical exposure with primary closure of the BA in 15 (9.6%) cases (10, 7F; 4, 6F; 1, 5F). Manual compression was used for hemostasis at the conclusion of all percutaneous cases. RESULTS: There were 2 (1.3%; 2/157 cases) deaths in the perioperative period, one due to myocardial infarction and the other from mesenteric ischemia. Access site complications occurred in 10.6% (15/142) of percutaneous cases, which required open surgical repair for bleeding (8) and BA thrombosis (7). There was an increased risk of complications with increasing sheath size in the percutaneous approach: 5.4% (2/37), 12.4% (11/89), and 12.5% (2/16) for 5F, 6F, and 7F sheaths, respectively (P = 0.49). None of the 15 patients who underwent surgical treatment suffered long-term vascular or neuropathic complications. CONCLUSIONS: In our experience, percutaneous BA access was associated with a 10% complication rate with an increased risk of complications associated with increasing sheath size. There was approximately the same incidence of bleeding as thrombosis. For patients who require 6 or 7F sheaths via a BA approach, we recommend more liberal use of open surgical exposure and primary BA repair.
BACKGROUND: A percutaneous brachial artery (BA) approach is a suitable or even favorable alternative to femoral artery access when performing certain endovascular interventions. However, this approach may have a higher complication rate compared to femoral artery access. We analyzed our results using percutaneous BA approach for noncardiac endovascular interventions. METHODS: Between January 1, 2003 and December 31, 2017, BA access was used in 157 cases performed on 136 patients. The procedures included 102 (65%) therapeutic interventions and 55 (35%) diagnostic studies. The vessels studied or treated included lower extremity arteries (48), the aorta and iliac arteries (45), mesenteric arteries (45), failing arterial revascularizations (24), renal arteries (9), subclavian arteries (8), carotid arteries (2), and visceral aneurysms (2), or in conjunction with endovascular aneurysm repair (EVAR), fenestrated EVAR, or thoracic EVAR (8). More than 1 vessel was studied or treated in 34 cases. Sheath sizes included 5F in 38 (24%) cases, 6F in 93 (59%) cases, and 7F in 26 (17%) cases. Percutaneous puncture was utilized in 142 (90.4%) cases and planned surgical exposure with primary closure of the BA in 15 (9.6%) cases (10, 7F; 4, 6F; 1, 5F). Manual compression was used for hemostasis at the conclusion of all percutaneous cases. RESULTS: There were 2 (1.3%; 2/157 cases) deaths in the perioperative period, one due to myocardial infarction and the other from mesenteric ischemia. Access site complications occurred in 10.6% (15/142) of percutaneous cases, which required open surgical repair for bleeding (8) and BA thrombosis (7). There was an increased risk of complications with increasing sheath size in the percutaneous approach: 5.4% (2/37), 12.4% (11/89), and 12.5% (2/16) for 5F, 6F, and 7F sheaths, respectively (P = 0.49). None of the 15 patients who underwent surgical treatment suffered long-term vascular or neuropathic complications. CONCLUSIONS: In our experience, percutaneous BA access was associated with a 10% complication rate with an increased risk of complications associated with increasing sheath size. There was approximately the same incidence of bleeding as thrombosis. For patients who require 6 or 7F sheaths via a BA approach, we recommend more liberal use of open surgical exposure and primary BA repair.
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