title: CUSUM analysis of brachial artery access for peripheral endovascular interventions.
abstract: OBJECTIVE
  Evaluate efficacy and safety of diagnostic and therapeutic endovascular interventions performed through transbrachial approach. Transbrachial artery catheterization has long been considered a secondary access site due to its related complication rate (7-11%). Low-profile and long-delivery endovascular systems, however, are reviving the interest in this approach.
  
  
  METHODS
  We retrospectively analysed all endovascular interventions attempted through a brachial artery access from 2003 to 2010. Two hundredth thirty seven consecutive patients (mean age 68.5 years, 89.5% male) underwent 168 transbrachial diagnostic (70.9%) and 69 therapeutic procedures (29.1%), characterised by micropuncture access (100%), 4-to-7 Fr sheath delivery systems and final digital compression (100%). CUSUM curves were created to evaluate learning effects and quality of care.
  
  
  RESULTS
  All but one procedure were completed according to their scheduled intention. The overall complication rate was 5.5% (5 pseudoaneurysms (2.1%), 4 transient ischemic attack (1.7%), 3 brachial artery thromboses (1.3%) and 1 cardiac tamponade (0.4%). Surgical intervention was required in four of these patients (30.8%). No significant differences were observed according to age or sex. CUSUM curves created at a 2% theoretical risk showed two statistically significant upward inflections: one early in the series associated with diagnostic procedures (P=0.043) and another at the end of the study related to therapeutic interventions (P=0.018).
  
  
  CONCLUSIONS
  Transbrachial catheterization is an effective and relatively safe access site for endovascular procedures. Its complication rate, although lower than before, still deserve it as a secondary access site. CUSUM curves let identify learning effects in diagnostic and interventional procedures.
authors.affiliation: Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain - lauracalsina@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Calsina Juscafresa
authors.forename: C
authors.initials: C
authors.lastname: Llort Pont
authors.forename: A
authors.initials: A
authors.lastname: Clará Velasco
mesh_terms: D000368:Aged; D001916:Brachial Artery; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D008297:Male; D011237:Predictive Value of Tests; D011677:Punctures; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome