Abstract
PurposeThe current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications.Materials and methodsThis is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis.ResultsSeventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred.ConclusionExclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.
Highlights
Since the advent of endovascular procedures, transfemoral access via the common femoral artery has been the preferred access site (Judkins 1967)
Seventy-five procedures in seventy-one patients were performed in the study period using brachial access
Mean sheath size in all complications was 5.66F, mean sheath size for the remaining cohort was 4.86F. In this retrospective study, we report our experience with ultrasound guided brachial artery access for endovascular procedures (Figs. 1 and 2)
Summary
Since the advent of endovascular procedures, transfemoral access via the common femoral artery has been the preferred access site (Judkins 1967). Ultrasound (US)-guidance was shown to improve the success rate of first-attempt arterial punctures while decreasing the time, as well as lowering the local complications such as hematomas from 3.4% to 1.4% (Shiloh et al 2011; Seto et al 2010a; 2010b). Transradial access can be limited by the vessel size prohibiting larger sheath placement than 7F and the prolonged distance from the puncture site to the target area which may especially problematic when access to the abdominal or lower extremities is required (Chen and Peterson 2019). Radial artery spasm, radial or ulnar artery occlusion, as well radial artery tortuosity or anomalies can impede the transradial access (Mason et al 2018; Seto et al 2015; Pancholy et al 2016) The major complication rate of radial arterial access is described as low as 0.5%, whereas the crossover rate is 4.9% (Burzotta et al 2012)
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