Efficacy and Safety of Transbrachial Access for Iliac Endovascular Interventions
Konstantinos Stavroulakis1, Marco V Usai2, Giovanni Torsello3
1Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany stavroulakis.konstantinos@yahoo.gr.
Insights
Brachial artery access is a viable option for treating iliac artery disease, achieving 81% primary technical success. However, access site complications and stroke remain significant concerns with this approach.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Iliac artery disease significantly impacts patient mobility and limb viability.
- Endovascular treatments offer less invasive options compared to open surgery.
- Brachial artery access presents an alternative route for complex endovascular procedures.
Purpose of the Study:
- To assess the efficacy and safety of brachial artery access for endovascular treatment of iliac artery disease.
- To determine technical success rates and identify potential complications associated with the transbrachial approach.
- To compare outcomes with historical or alternative access methods.
Main Methods:
- Retrospective review of 201 patients undergoing endovascular iliac artery treatment via brachial access.
- Analysis of patient demographics, lesion characteristics (TASC II C/D), and presenting symptoms (claudication, critical limb ischemia).
- Evaluation of primary technical success (brachial only), secondary technical success (adjunctive transfemoral), access site complications, and cerebrovascular events (stroke/TIA).
Main Results:
- Primary technical success was achieved in 81% of cases, with an overall technical success rate of 92% including transfemoral intervention.
- Access site complications included hematomas (4%), pseudoaneurysms (4%), and bleeding (2%).
- Stroke/TIA occurred in 2% of patients, and mortality was 0.5%. Female gender was associated with higher complication rates.
Conclusions:
- Brachial artery access is feasible for a majority of endovascular iliac artery disease treatments.
- An adjunctive transfemoral approach may be necessary in a subset of patients.
- High rates of access site complications and cerebral events necessitate careful consideration of the transbrachial approach.
Purpose:
To evaluate the use of a brachial artery access for endovascular treatment of iliac artery disease.
Methods:
A retrospective review was conducted of 201 patients (mean age 73 years; 147 men) treated via a brachial artery access for iliac artery stenosis. The majority (n=141, 70%) presented with lifestyle-limiting claudication (Rutherford category 3), whereas the incidence of critical limb ischemia (Rutherford categories 4-6) was 30% (n=70). Diagnostic angiography revealed a TransAtlantic Inter-Society Consensus II (TASC) C/D lesion in 114 (57%) patients. The primary outcome was technical success achieved exclusively with a brachial artery access. Secondary outcomes were secondary technical success (adjunctive transfemoral access), access site complications, and stroke/transient ischemic attack (TIA).
Results:
In 17 (8%) patients, lesion crossing was unsuccessful, while an adjunctive transfemoral approach was necessary to restore iliac vessel patency in 23 (11%) cases. Thus, the primary and secondary technical success rates were 81% and 92%, respectively. Local hematomas (9, 4%) dominated the access site complications, followed by pseudoaneurysms (8, 4%), late brachial artery bleeding (4, 2%), brachial artery occlusion (2, 1%), and puncture site infection (2, 1%). No transient or permanent median nerve dysfunction was observed. The stroke/TIA rate was 2% (n=4). A single patient died due to acute coronary syndrome (0.5% mortality). TASC II class (p=0.58), sex (p=0.66), and target vessel (p>0.3 for all locations) had no effect on technical success. Female gender unfavorably influenced the incidence of access site complications (hazard ratio 6.7, 95% confidence interval 2.7 to 15, p<0.001), but sheath size did not (p=0.22).
Conclusion:
Brachial artery access enables endovascular treatment of iliac artery disease in the majority of patients, although an adjunctive transfemoral access may be required. However, the high incidences of access site complications and cerebral events remain a significant limitation of the transbrachial approach.
