Percutaneous versus Open Brachial Access for Vascular Interventions: A Systematic Review and Meta-Analysis

Brachial artery access is an important alternative when femoral access is not feasible for peripheral vascular interventions. Although percutaneous brachial access (PBA) has become increasingly common, open brachial access (OBA) may offer lower complication rates. This systematic review and meta-analysis compared outcomes between PBA and OBA.

A systematic search of PubMed, Embase, and Cochrane Library through July 2025 was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Observational cohort studies reporting outcomes for PBA versus OBA in noncoronary vascular interventions were included. The primary outcome was access-site complications requiring intervention; secondary outcomes included overall access-site complications, hematoma, thrombosis, pseudoaneurysm, nerve injury, and 30-day mortality. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Six studies encompassing 2,615 patients (1,954 PBA; 661 OBA) met the inclusion criteria. PBA was associated with a significantly higher rate of access-site complications requiring intervention compared with OBA (RR 3.63; 95% CI, 2.08-6.32; P = 0.010). In addition, access-site complications not requiring intervention were also significantly lower in the OBA group (RR 2.68; 95% CI, 1.08-6.62; P = 0.003). No significant differences were observed between groups for hematoma, thrombosis, pseudoaneurysm, nerve injury, or 30-day mortality. The certainty of evidence was rated as low to very low across outcomes due to the observational design, risk of bias, and imprecision.

PBA remains the preferred approach for brachial access but carries a significantly higher risk of access site complications requiring intervention compared with OBA. These findings support careful patient selection, ultrasound-guided puncture, and meticulous hemostasis when PBA is used. Larger prospective studies are needed to refine access-site strategy and optimize outcomes.