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CUSUM analysis of brachial artery access for peripheral endovascular interventions
L Calsina Juscafresa1, C Llort Pont, A Clará Velasco
1Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain - lauracalsina@gmail.com.
Insights
Transbrachial catheterization is an effective and safe approach for endovascular procedures. While complications are lower than previously reported, it remains a secondary access site, with CUSUM curves identifying learning effects.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Transbrachial artery catheterization is often a secondary access site due to historical complication rates (7-11%).
- Advancements in low-profile, long-delivery endovascular systems are increasing interest in this approach.
- Evaluating the safety and efficacy of transbrachial access for modern endovascular procedures is crucial.
Purpose of the Study:
- To assess the efficacy and safety of diagnostic and therapeutic endovascular interventions using the transbrachial approach.
- To analyze complication rates associated with transbrachial access in a contemporary series.
- To identify learning effects and quality improvements using CUSUM analysis.
Main Methods:
- Retrospective analysis of 237 endovascular interventions via brachial artery access (2003-2010).
- Procedures included 168 diagnostic and 69 therapeutic interventions using micropuncture and 4-7 Fr sheaths.
- Cumulative Sum (CUSUM) curves were employed to evaluate learning curves and procedural quality.
Main Results:
- Overall complication rate was 5.5%, including pseudoaneurysms (2.1%), transient ischemic attack (1.7%), and brachial artery thrombosis (1.3%).
- Surgical intervention was required in 30.8% of patients with complications.
- CUSUM analysis revealed significant learning effects in both diagnostic (P=0.043) and therapeutic (P=0.018) procedures.
Conclusions:
- Transbrachial catheterization is a viable and relatively safe access route for endovascular procedures.
- Complication rates are lower than historical data, but it remains a secondary access site.
- CUSUM curves effectively identified learning effects, aiding in quality assessment for diagnostic and interventional procedures.
Aim:
Evaluate efficacy and safety of diagnostic and therapeutic endovascular interventions performed through transbrachial approach. Transbrachial artery catheterization has long been considered a secondary access site due to its related complication rate (7-11%). Low-profile and long-delivery endovascular systems, however, are reviving the interest in this approach.
Methods:
We retrospectively analysed all endovascular interventions attempted through a brachial artery access from 2003 to 2010. Two hundredth thirty seven consecutive patients (mean age 68.5 years, 89.5% male) underwent 168 transbrachial diagnostic (70.9%) and 69 therapeutic procedures (29.1%), characterised by micropuncture access (100%), 4-to-7 Fr sheath delivery systems and final digital compression (100%). CUSUM curves were created to evaluate learning effects and quality of care.
Results:
All but one procedure were completed according to their scheduled intention. The overall complication rate was 5.5% (5 pseudoaneurysms (2.1%), 4 transient ischemic attack (1.7%), 3 brachial artery thromboses (1.3%) and 1 cardiac tamponade (0.4%). Surgical intervention was required in four of these patients (30.8%). No significant differences were observed according to age or sex. CUSUM curves created at a 2% theoretical risk showed two statistically significant upward inflections: one early in the series associated with diagnostic procedures (P=0.043) and another at the end of the study related to therapeutic interventions (P=0.018).
Conclusion:
Transbrachial catheterization is an effective and relatively safe access site for endovascular procedures. Its complication rate, although lower than before, still deserve it as a secondary access site. CUSUM curves let identify learning effects in diagnostic and interventional procedures.
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