title: Endovascular Treatment of Atherosclerotic Iliac Stenosis: Local and Systemic Complications of the Open Brachial Access.
abstract: BACKGROUND
  The femoral access is the approach of reference for iliac angioplasty. In the current context of an early ambulation and a minimization of in-hospital stay period, the brachial access seems to be an appropriate approach, especially that long and small diameter equipments are available. Furthermore, it is extremely useful in case of inappropriate or unavailable femoral access. The aim of this study was to evaluate the complication risk factors of the brachial approach in the treatment of iliac stenosis.
  
  
  METHODS
  Between January 2012 and December 2013, we performed 281 iliac transluminal angioplasties of which 57 (20%) consecutive left brachial artery accesses were performed in 54 patients. The choice of brachial access was justified in 68% of the cases by an unavailable femoral access, in 29% of the cases by the presence of bilateral iliac lesions, and in 3% of the cases after failure of retrograde femoral approach.
  
  
  RESULTS
  The patients were of a male majority (81%) with a mean age of 66 ± 9 years. The procedure was performed under local anesthesia in 65% of the cases. No upper limb ischemia or nervous complications had been reported. No cerebrovascular stroke has been identified. One patient presented with dysarthria associated with disorientation without the presence of cerebrovascular ischemia on the computed tomography scan and on the magnetic resonance imaging. There were 3 major hematomas at the brachial access site, which required reoperation; these 3 patients were on dialysis. There was no statistically significant relationship between a complication occurrence and the diameter or length of the introducer. The mean in-hospital stay period was 2 days. The procedure was considered successful in 91% of the cases. We reported 5 cases of failure: 4 of which was due to a difficulty in crossing the lesion and 1 due to a very short material. The only significant risk factor of failure was the thrombosis of the iliac axis (odds ratio 23.3, 95% confidence interval 2.5-264.6, P = 0.003).
  
  
  CONCLUSIONS
  The femoral access remains the recommended approach for the treatment of iliac occlusive lesions. However, brachial artery access seems to provide a safe and secure alternative approach for patients when femoral artery access is unavailable. It allows a rapid ambulation and an ambulatory care.
authors.affiliation: CHU de Brest, Service de Chirurgie Vasculaire, Brest, France. Electronic address: nasr.bahaa@gmail.com.
authors.forename: Bahaa
authors.initials: B
authors.lastname: Nasr
authors.affiliation: CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Albert
authors.affiliation: CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: David
authors.affiliation: CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khalifa
authors.affiliation: CHU de Brest, Centre Regional de Pharmacovigilance, Brest, France.
authors.forename: Layal
authors.initials: L
authors.lastname: El Aridi
authors.affiliation: CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
authors.forename: Ali
authors.initials: A
authors.lastname: Badra
authors.affiliation: CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Braesco
authors.affiliation: CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Gouny
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome