Brachial artery access for endovascular procedures: how safe is it?

While femoral and radial artery access are routine for endovascular procedures, brachial artery access remains an important alternative in selected cases. This study aimed to evaluate the complication rate of percutaneous brachial artery access at a tertiary centre and identify potential risk factors for access-site complications.

A retrospective review was performed of all procedures utilising percutaneous brachial artery access over a 12.5-year period. Patient demographics, sheath size, closure technique and complications were recorded. Complications were classified according to the CIRSE classification system.

One hundred percutaneous brachial artery punctures were identified. Sheath sizes ranged from 3 to 9 Fr; the majority (57%) using 6 Fr. Most procedures (84%) were performed for aortic, mesenteric/renal, or peripheral arterial interventions. Overall, 23 complications occurred (23%), including 9 (9%) grade 3 complications requiring additional treatment. No convincing association was identified between complication rate and patient age, gender, or sheath size. Vascular closure devices were used in seven cases, five of which resulted in complications, including three grade 3 events.

The complication rate associated with brachial artery access in this series was higher than that reported in much of the published literature. These findings suggest that brachial artery access may be less safe than commonly perceived and that vascular closure devices should be used with caution, particularly given their off-label status for this access site. Standardised procedural protocols and post-procedural care pathways may help reduce complication rates. Broader auditing and reporting across centres are encouraged to better define best practice.