Abstract
Endovascular access is usually achieved through the common femoral artery due to its large size and accessibility. Access through the upper extremity can however be necessary due to anatomic reasons, obesity, or peripheral arterial disease. The 2 main methods of access are surgical cutdown and percutaneous puncture. In this single-centre retrospective cohort study we compared complication risks for both surgical cutdown and percutaneous puncture of an upper arm approach. Data was obtained from patients receiving endovascular access through the brachial or axillary artery between 2005 and 2018. A total of 109 patients were included. Patient demographics including age, sex, medical history, smoking status, and actual medication were registered, as well as postoperative complications including hematoma, thrombosis, dissection, infection, pseudoaneurysm, nerve injury, reoperation, and readmission. Access was achieved through surgical cutdown in 53% (n=58) and through percutaneous puncture in 47% (n=51) of patients. Fifty-eight percent (n=63) received access via the brachial artery (BA) and 42% (n=46) via the axillary artery. Complication rate was 25.0% (3 of 12) for surgical cutdown via the BA, 29.4% (15 of 51) for percutaneous puncture via the BA, and 10.9% (5 of 46) for surgical cutdown via the axillary artery. Major complication rate was 8.3% (1 of 12) for surgical cutdown via the BA, 13.7% (7 of 51) for percutaneous puncture via the BA, and 4.3% (2 of 46) for surgical cutdown via the axillary artery. There was no association between baseline patient characteristics and complication rate. In this nonrandomized retrospective study, surgical cutdown via the axillary artery was the safest option with fewest complications, but selection of patients may have blurred the results. Surgical cutdown and percutaneous puncture seem equally safe in terms of complication rate in the BA.
Highlights
In the last two decades endovascular treatment of both aortic aneurysmal and aortic occlusive disease has gained widespread adoption, mainly due to high efficacy and safety1.Vascular access is usually achieved through the common femoral artery as it is accessible and can accommodate large sheaths2
Access was achieved through surgical cutdown in 53% (58 of 109) and through percutaneous puncture in 47% (51 of 109) of patients
This study evaluated vascular access complications seen in brachial artery (BA) and axillary artery (AxA) endovascular approaches for mesenteric stents or endograft procedures
Summary
Vascular access is usually achieved through the common femoral artery as it is accessible and can accommodate large sheaths. Access through the upper extremity is sometimes necessary due to specific anatomic configurations, obesity, or peripheral arterial disease, and can be achieved through the brachial artery (BA) and axillary artery (AxA). Vascular access through the upper extremity is especially useful in fenestrated and branched endovascular aneurysm repair (FEVAR, BEVAR), as well as in PTA/stenting of the mesenteric or renal arteries. Access through the upper extremity is associated with smaller vessel size and spasms, resulting in complications such as dissection, bleeding, arteriovenous fistula, pseudoaneurysm formation, or thrombosis. Results in literature report a wide range of complication rates in brachial versus femoral access. Possible explanations include differences in patient selection and study design
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