Percutaneous Brachial Access Associated with Increased Incidence of Complications Compared to Open Exposure for Peripheral Vascular Interventions in Contemporary Series.

OBJECTIVES While percutaneous brachial access is being used more commonly for peripheral vascular interventions (PVI), prior studies have suggested open brachial artery exposure for access is associated with fewer complications than percutaneous access. This study sought to determine the incidence of complications for each access method and identify predictors of access site complications following brachial access. METHODS The Vascular Quality Initiative national database was queried for all patients who underwent PVI with brachial artery access from the years 2016-2019. Procedures with simultaneous thrombolysis or open procedures were excluded. The primary outcome was any perioperative brachial artery access complications; multivariable logistic regression was used to identify associated predictors. RESULTS There were 1,400 procedures performed on 1,242 patients; 189 procedures (13.5%) utilized open exposure. Mean age was 67.3±9.5 and 55.7% of procedures were on males. There were no significant demographic differences between the open and percutaneous groups. Open exposure procedures were more likely to utilize sheaths larger than 5 french (Fr) (79.4% vs 59.0%; p-value<0.001) and treat more arteries (2.0±1.8 vs 1.7±0.9; p-value<0.001), but less likely to utilized multiple access sites (8.5% vs 20.1%; p-value<0.001). Access complications occurred in 7.5% of percutaneous procedures and 1.6% of open exposures (p=0.003). Percutaneous access was independently associated with brachial access complications (OR 5.92, 95%CI: 1.76-19.9; p-value=0.004). Other associated factors included female sex (OR 2.23, 95%CI: 1.44-3.44; p-value<0.001), CHF (OR 2.02, 95%CI: 1.26-3.24;p-value=0.003), and increasing sheath size (OR 1.36 per Fr, 95%CI: 1.07-1.72; p-value=0.011); diabetes was protective (OR 0.53, 95%CI: 0.33-0.83; p-value=0.006). CONCLUSIONS Open exposure may be advantageous over percutaneous access in terms of preventing complications after brachial access, however, the difference in complications is driven by hematomas that were managed nonoperatively. Operative complications were more common in the percutaneous group, although this did not reach statistical significance. Percutaneous access should be used cautiously in women, patients with a history of CHF, non-diabetics, and interventions where larger sheaths are required.