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Percutaneous versus Open Brachial Access for Vascular Interventions: A Systematic Review and Meta-Analysis
Eren Çetinel1, Mostafa Labib2, Andressa Frankowski Dagostin1
1San Raffaele University, Milan, Italy.
Annals of Vascular Surgery
|November 5, 2025
Summary
Percutaneous brachial access (PBA) is common for vascular interventions but has higher complication rates requiring intervention than open brachial access (OBA). Careful patient selection and technique are crucial for PBA safety.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- Brachial artery access is a key alternative to femoral access in peripheral vascular interventions.
- Percutaneous brachial access (PBA) is increasingly utilized, but open brachial access (OBA) may have lower complication rates.
Purpose of the Study:
- To compare the outcomes of percutaneous brachial access (PBA) versus open brachial access (OBA) in noncoronary vascular interventions.
- To evaluate access-site complications, hematoma, thrombosis, pseudoaneurysm, nerve injury, and mortality between PBA and OBA.
Main Methods:
- Systematic review and meta-analysis of observational cohort studies.
- Searched PubMed, Embase, and Cochrane Library through July 2025.
- Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.
Main Results:
- Six studies with 2,615 patients (1,954 PBA; 661 OBA) were included.
- PBA had significantly higher rates of access-site complications requiring intervention (RR 3.63) and overall complications (RR 2.68) compared to OBA.
- No significant differences were found in hematoma, thrombosis, pseudoaneurysm, nerve injury, or 30-day mortality.
Conclusions:
- PBA, while preferred, carries a significantly higher risk of access-site complications requiring intervention than OBA.
- Findings support careful patient selection, ultrasound guidance, and meticulous hemostasis for PBA.
- Larger prospective studies are needed to optimize brachial access strategies.
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