Open Brachial Access for Endovascular Treatment: Our Five Years Institutional Experience

Abstract

Endovascular treatment has currently replaced open surgical procedures as the first-line treatment for many vascular diseases. Hence, besides mastery in endovascular techniques and instruments, Vascular surgeons must be well versed with various endovascular access sites too. Presently, Common Femoral Artery (CFA) is the most common access site being used for percutaneous as well as open vascular access for endovascular management of upper /lower limbs, Aorto-iliac, carotid and arch vessels diseases. However, though Brachial use is being selectively used as vascular access, especially when CFA can’t be used (groin sepsis, Aorto-iliac occlusion, abnormal femoral anatomy, severe calcification etc) or failure/adjunct to CFA access (e.g – complex thoracic/ abdominal aneurysm), its use haith the advancement and complexity of endovascular management. This study was an observational retrospective study conducted between June 2015 - September 2020 at a tertiary care hospital and was aimed at critical analysis various aspect of brachial access including the target arteries and complications. A total of 72 patients were included in this study, most of the patients were male (80%) and mean age of presentation was 60.79 with SD of 14.9 years. Patients were predominantly Male (58/72). The left brachial was accessed in 87.5%, right in 6.9% and both brachial arteries were accessed in 5.6% of patients.Iliac artery was the most common target artery (32 %), which were approached via trans-brachial access, followed by SCA (26%) and Abdominal Aorta (18%). Overall complication rate was 5.55 %. Hematoma was observed in two patients, one patient had brachial artery thrombosis and one patient developed brachial artery pseudoaneurysm. Our limited study suggests that brachial approach is safe and suitable in difficult aorto-iliac lesions and also as an adjunct or alternative to femoral access in specific cases.