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PVSS22. The Brachial Artery: A Critical Access for Complex Endovascular Procedures

Javier A. Alvarez-Tostado, Mireille A. Moise, James F. Bena, Mircea Pavkov, Daniel G. Clair, Vikram S. Kashyap.
Cleveland Clinic Foundation, Cleveland, Ohio.

OBJECTIVES: The brachial artery is often used for coronary angiography. However, data on brachial access for aortic and peripheral interventions is scant. The purpose of this study was to evaluate our experience with brachial artery catheterization for diagnostic arteriography and endovascular interventions.

METHODS: Between August 2004 and August 2005), 2026 endovascular procedures were performed. Of these, 323 cases (16%) in 299 patients required brachial artery access forming the basis for this study. Patients subjected to multiple interventions but with a single access (i.e., thrombolysis) were considered a single case. Demographic and clinical data were recorded onto a database and analyzed. Average length of follow-up was 18.6±11 months. Data were analyzed using Fisher’s exact test and logistic regression analyses.

RESULTS: The mean age of all patients was 66.4 years with 57% male. Brachial access was used for diagnostic purposes in 27.2% and for interventions including angioplasty, stenting, and thrombolysis in 72.8%. The use of brachial access was considered obligatory in 40%, adjunctive in 19% (i.e. endovascular AAA and TAA repair) and preferential to femoral access in 41%. Brachial artery access was achieved in all but three patients (99% technical success rate). Hemostasis after catheterization was achieved by manual compression in 88% of the cases. Operative mortality rate was 5.8% and not related to brachial artery access in any case. Brachial access site related complications occurred in 21 patients (6.6%). Thirteen patients (62%) required a surgical procedure mostly for brachial artery thrombosis or pseudoaneurysm. Patients with complications were more commonly female (Odds Ratio 4.7, p=0.003) and had a long interventional sheath (OR 6.8, p=0.012). The risk of a brachial artery complication was not associated with thrombolysis, procedure type or vascular territory treated. Also, the use of heparin, protamine or closure device was not associated with increased complication risk. There was no upper extremity limb/finger loss in this experience.

CONCLUSIONS: Brachial artery access is necessary for complex endovascular procedures and can be achieved in most patients safely. Post-procedure vigilance is warranted since a majority of patients with complications will require operative correction.