title: Efficacy and Safety of Transbrachial Access for Iliac Endovascular Interventions.
abstract: OBJECTIVE
  To evaluate the use of a brachial artery access for endovascular treatment of iliac artery disease.
  
  
  METHODS
  A retrospective review was conducted of 201 patients (mean age 73 years; 147 men) treated via a brachial artery access for iliac artery stenosis. The majority (n=141, 70%) presented with lifestyle-limiting claudication (Rutherford category 3), whereas the incidence of critical limb ischemia (Rutherford categories 4-6) was 30% (n=70). Diagnostic angiography revealed a TransAtlantic Inter-Society Consensus II (TASC) C/D lesion in 114 (57%) patients. The primary outcome was technical success achieved exclusively with a brachial artery access. Secondary outcomes were secondary technical success (adjunctive transfemoral access), access site complications, and stroke/transient ischemic attack (TIA).
  
  
  RESULTS
  In 17 (8%) patients, lesion crossing was unsuccessful, while an adjunctive transfemoral approach was necessary to restore iliac vessel patency in 23 (11%) cases. Thus, the primary and secondary technical success rates were 81% and 92%, respectively. Local hematomas (9, 4%) dominated the access site complications, followed by pseudoaneurysms (8, 4%), late brachial artery bleeding (4, 2%), brachial artery occlusion (2, 1%), and puncture site infection (2, 1%). No transient or permanent median nerve dysfunction was observed. The stroke/TIA rate was 2% (n=4). A single patient died due to acute coronary syndrome (0.5% mortality). TASC II class (p=0.58), sex (p=0.66), and target vessel (p>0.3 for all locations) had no effect on technical success. Female gender unfavorably influenced the incidence of access site complications (hazard ratio 6.7, 95% confidence interval 2.7 to 15, p<0.001), but sheath size did not (p=0.22).
  
  
  CONCLUSIONS
  Brachial artery access enables endovascular treatment of iliac artery disease in the majority of patients, although an adjunctive transfemoral access may be required. However, the high incidences of access site complications and cerebral events remain a significant limitation of the transbrachial approach.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany stavroulakis.konstantinos@yahoo.gr.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stavroulakis
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany Department of Vascular Surgery, St. Franziskus-Hospital Münster, Germany Division of Vascular Surgery, Knappschaftskrankenhaus Recklinghausen, Germany.
authors.forename: Marco V
authors.initials: MV
authors.lastname: Usai
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Schwindt
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Stachmann
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany.
authors.forename: Efthymios
authors.initials: E
authors.lastname: Beropoulis
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster Hospital, Münster, Germany.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011677:Punctures; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome
keywords: access site; angioplasty; brachial artery; catheterization; complication; iliac artery; stenosis; transbrachial approach