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Complication rates of percutaneous brachial artery access in peripheral vascular angiography
Peter J Armstrong1, David C Han, John A Baxter
1Section of Vascular Surgery, Geisinger Medical Center, Danville, PA, USA.
Insights
Percutaneous brachial artery access is safe for peripheral vascular disease (PVD) patients, enabling early ambulation. However, women experienced higher rates of failed access and brachial thrombosis.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Brachial artery access is often secondary to femoral access due to perceived higher complication rates.
- Potential advantages exist for peripheral vascular disease (PVD) patients with brachial access.
- Previous studies have not definitively established safety and efficacy in a large PVD cohort.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous brachial artery access in PVD patients undergoing angiography.
- To compare complication rates between brachial and femoral access in this specific patient population.
- To identify patient-specific factors influencing brachial access outcomes.
Main Methods:
- Retrospective review of a prospectively collected database of 1326 PVD patients.
- Analysis of percutaneous brachial artery access for angiography between 1990 and 1999.
- Inclusion of vascular surgery evaluation and 24-hour nurse follow-up protocols.
Main Results:
- Overall complication rate was low at 1.28%.
- Failed access (2.1% vs 0%) and brachial thrombosis (1.24% vs 0.28%) were significantly higher in women.
- Multiple repeat brachial access procedures were performed without complication in a subset of patients.
Conclusions:
- Percutaneous brachial artery access is safe and effective for diagnostic angiography in PVD patients.
- Women represent a subgroup with increased risk for access failure and thrombosis.
- The brachial approach facilitates early ambulation and discharge, supporting its consideration as a primary access route.
Abstract:
The brachial artery has been considered a secondary choice for percutaneous access due to reported increased complication rates compared to femoral access despite potential advantages in peripheral vascular disease (PVD) patients. A prospectively collected database of 1326 PVD patients undergoing angiography with percutaneous brachial access between January 1, 1990 and December 31, 1999 was retrospectively reviewed. All patient charts with coded brachial pathology during this time period were reviewed to ensure complete data capture. The protocol for patients undergoing brachial access included a vascular surgery evaluation after each angiogram and telephone follow-up by a nurse at 24 hr. During this 10-year period, a percutaneous brachial artery approach was used to perform 1084 angiograms in men and 242 angiograms in women. A subset of 111 patients had multiple studies (range: 2 to 7) via brachial access without complication. Rates of failed access (2.1% female vs. 0% male, p <0.001) and brachial thrombosis (1.24% female vs. 0.28% male, p <0.04) were significantly higher in women. The complication rate for all patients was 1.28%. Percutaneous brachial access for angiography can be safely and repetitively performed in PVD patients, although women have an increased risk of thrombosis and failed access. The brachial approach allows early ambulation and discharge, and can be considered a primary choice for diagnostic angiographic access.