Comparison of Access-Site Complications after Brachial Artery Approach for Endovascular Treatment of Lower Extremity Peripheral Arterial Disease: Open Vs Percutaneous Access

Naga, Ahmad; Allam, Ahmed K.; Mohamed, Mohamed Ismail

doi:10.21608/asjs.2024.326500.1164

Comparison of Access-Site Complications after Brachial Artery Approach for Endovascular Treatment of Lower Extremity Peripheral Arterial Disease: Open Vs Percutaneous Access

Document Type : Original Article

Authors

¹ Department of General Surgery, Faculty of Medicine, University of Alexandria, Egypt

² Department of General Surgery, Faculty of Medicine, Benha University, Egypt

³ Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt

10.21608/asjs.2024.326500.1164

Abstract

Introduction: Endovascular treatment of lower extremity peripheral arterial disease (PAD) is in continuous
development. Although the groin is the commonplace gate for the majority of peripheral endovascular interventions,
still the brachial artery (BA) access has its indications. Recently we have noticed an unexplained personal variation
among interventionists in our unit in performing a brachial percutaneous access versus open surgical cutdown.
Aim of work: The aim of this study is to look at the short-term access site complications after brachial artery
approach for PAD endovascular interventions, comparing open to percutaneous access.
Patients and methods: This was a retrospective observational study, where 90 patients who underwent PAD
endovascular interventions through a brachial approach at three university-based vascular services; Alexandria,
Benha and Ain Shams universities between July 2022 and May 2024 were reviewed. Patients were divided into 2
groups: Open access (OA) and Percutaneous access (PA) groups.
Results: OA group patients had longer hospital stay; 7.42 + 3.4 days as compared to 5.18 + 1.2 days in PA group.
However, the complication rate was far less in OA group; 6 (12%) cases if compared to 10 (24%) in PA group.
In a logistic regression model, the factors that were found to predict complications -regardless to the approach
performed – were smoking, dual anti-platelets therapy and increasing the size of the sheath used.
Conclusion: The study findings recommend for the BA access to use the open surgical approach, use the ultrasound
guided technique if PA is chosen and minimize the size of sheaths used as much as possible.

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