title: Arterial cutdown reduces complications after brachial access for peripheral vascular intervention.
abstract: OBJECTIVE
  Factors influencing risk for brachial access site complications after peripheral vascular intervention are poorly understood. We queried the Society for Vascular Surgery Vascular Quality Initiative to identify unique demographic and technical risks for such complications.
  
  
  METHODS
  The Vascular Quality Initiative peripheral vascular intervention data files from years 2010 to 2014 were analyzed to compare puncture site complication rates and associations encountered with either brachial or femoral arterial access for peripheral vascular intervention. Procedures requiring multiple access sites were excluded. Complications were defined as wound hematoma or access vessel stenosis/occlusion. Univariate and hierarchical logistic regression was used to identify independent factors associated with site complications after brachial access.
  
  
  RESULTS
  Of 44,634 eligible peripheral vascular intervention procedures, 732 (1.6%) were performed through brachial access. Brachial access was associated with an increased complication rate compared with femoral access (9.0% vs 3.3%; P < .001), including more hematomas (7.2% vs 3.0%; P < .001) and access site stenosis/occlusion (2.1% vs 0.4%; P < .001). On univariate analysis, factors associated with brachial access complications included age, female gender, and sheath size. Complications occurred less frequently after arterial cutdown (4.1%) compared with either ultrasound-guided (11.8%) or fluoroscopically guided percutaneous access (7.3%; P = .07 across all variables). Neither surgeons' overall peripheral vascular intervention experience nor prior experience with brachial access predicted likelihood of adverse events. By multivariate analysis, male gender (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.28-0.84; P < .01) and arterial cutdown (OR, 0.25; 95% CI, 0.07-0.87; P = .04) were associated with significantly decreased risk for access complications. Larger sheath sizes (>5F) were associated with increased risk of complications (OR, 2.19; 95% CI, 1.07-4.49; P = .03).
  
  
  CONCLUSIONS
  Brachial access for peripheral vascular intervention carries significantly increased risks for access site occlusion or hematoma formation. Arterial cutdown and smaller sheath diameters are associated with lower complication rates and thus should be considered when arm access is required.
authors.affiliation: Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Kret
authors.affiliation: Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Dalman
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Mass.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kalish
authors.affiliation: Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif. Electronic address: mwmell@stanford.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mell
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000517:prevention & control; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003251:Constriction, Pathologic; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices