Arterial cutdown reduces complications after brachial access for peripheral vascular intervention

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Brachial access is an alternative to femoral access for peripheral vascular intervention (PVI).
• Factors influencing brachial access site complications are not well understood.
• Identifying these factors is crucial for improving patient safety during PVI procedures.

Purpose of the Study:

• To identify demographic and technical risk factors for brachial access site complications.
• To compare complication rates between brachial and femoral access for PVI.
• To inform best practices for brachial access in PVI.

Main Methods:

• Analysis of the Vascular Quality Initiative PVI database (2010-2014).
• Comparison of complication rates (hematoma, stenosis/occlusion) between brachial and femoral access.
• Univariate and multivariate logistic regression to identify independent risk factors for brachial access complications.

Main Results:

• Brachial access (1.6% of procedures) had higher complication rates (9.0%) than femoral access (3.3%).
• Complications included increased hematomas (7.2% vs 3.0%) and access site stenosis/occlusion (2.1% vs 0.4%) with brachial access.
• Arterial cutdown (4.1%) and male gender were associated with decreased risk, while larger sheath sizes (>5F) increased risk.

Conclusions:

• Brachial access for PVI is associated with significantly higher risks of access site complications.
• Arterial cutdown and smaller sheath diameters (<5F) are associated with lower complication rates.
• These findings suggest prioritizing arterial cutdown and smaller sheaths when brachial access is necessary for PVI.