Karla Maria Treitl MD, Presenter: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Marcus Treitl MD, Abstract Co-Author: Nothing to Disclose

Trans-brachial (TB) access for intervention is still believed to be dangerous, despite its advantages for the interventionalist and patient. The Aim of the study was to prospectively assess current limitations and complication rates of the TB access technique for endovascular treatment of peripheral vascular pathologies in comparison to the trans-femoral (TF) access technique for the first time.

In total, 300 patients (202 m; age 68.7 ± 11.0yrs) with arterial occlusive disease underwent endovascular therapy via a TB or TF access. Peri-procedural data (sheath size, dose area product, fluoroscopy, examination time) were analyzed. Post-procedural complications of the puncture sites were categorized as minor (local hematoma, pseudoaneurysm, embolization, dissection, minor bleeding) and major (thrombotic occlusion, hematoma requiring surgery, major bleeding, nerve injury) and analyzed by the Fisher`s exact and the Chi2-test according to the target lesions.

The minor and major complication rates of both groups did not significantly differ (21/14.0% vs. 26/17.3%, P=0.26; 4/2.7% vs. 3/2.0%, P=0.50). The dose area product and the fluoroscopy time were significantly higher in the TB-group (12752.1 ± 9524.5 cGycm2 vs. 6073.2 ± 6568.5 cGycm2; P=0.00; 24.3 ± 18.4 min vs. 18.9 ± 12.6 min; P=0.01), though examination times were comparable (121.8 ± 48.9 min vs. 125.0 ±44.2; P=0.57).

Results and complication rates of the TB-access are comparable to the TF-access for endovascular treatment of target lesions in peripheral or visceral artery occlusive disease, making it a safe and important alternative to TF access in selected cases. It is associated with a higher radiation exposure.

• Alternative access routes than the TF approach are necessary with increasing complexity of peripheral vascular disease or for certain peripheral artery targets • Puncture of the brachial artery is believed to have a higher risk for long term complications like nerve injury or vessel occlusion • Prior studies lack a direct comparison of TB and TF access complications and / or lack a standardized follow-up • In this prospective and comparative observation: o the minor and major complications rates of TB and TF access are comparable o theTB access leads to a higher radiation exposure o theTB access still is a valid alternative in patients, who cannot be examined or treated trans-femorally  

Treitl, K, Reiser, M, Treitl, M, Limitations and Complications of Trans-brachial Arterial Access for Endovascular Treatment of the Peripheral Vasculature: A Contemporary and Prospective Comparison to Trans-femoral Access.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14002710.html