Comparison of Postcatheterization Pseudoaneurysm between Brachial Access and Femoral Access

Abstract

Postcatheterization pseudoaneurysm is a serious complication following diagnostic or therapeutic catheterization. Because radial access is unsuitable in some situations, there is still a need to use femoral or brachial access for arterial catheterization. The aim of this study was to compare the incidence and clinical characteristics of pseudoaneurysm between brachial and femoral access. We identified patients who underwent arterial catheterization from our cardiac catheter records. A total of 5,990 cardiac catheter records and discharge summaries were reviewed, and 23 pseudoaneurysm cases were identified. Those pseudoaneurysm cases were divided into a brachial pseudoaneurysm group (n = 9) and a femoral pseudoaneurysm group (n = 14). The incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access (odds ratio: 4.16, 95% confidence interval: 1.80-9.65; P < 0.001). Successful manual compression was frequently achieved in both the brachial (77.8%) and the femoral (92.9%) pseudoaneurysm groups (P = 0.295). Surgical intervention was more frequently performed in the brachial pseudoaneurysm group (22.2%) than in the femoral pseudoaneurysm group (0%) without reaching statistical significance (P = 0.07). Moreover, neurological disorders were observed only in the brachial pseudoaneurysm group (22.2%). In conclusion, the incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access, indicating the potential risk of brachial access. Successful manual compression was frequently achieved in both groups, but neurological disorders were observed only in brachial access, suggesting the greater risk of brachial pseudoaneurysms.

Incidence of and predisposing factors for pseudoaneurysm formation in a high-volume cardiovascular center

“…In the upper limb, the radial and brachial arteries are the most common puncture sites, but the ulnar artery is also increasingly used [ 8 – 10 , 20 , 21 ]. Radial and ulnar punctures have a lower major complication rate than brachial and femoral punctures [ 9 , 10 , 20 – 23 ].…”

“…Major complications associated with the brachial approach include local thrombus formation, PSA, and nerve compression by hematoma and/or PSA [ 8 , 10 ]. In a study by Tamanaha et al [ 8 ], the prevalence of PSA and nerve compression by PSA was significantly higher in brachial (1.1% and 2.2%, respectively) than in femoral access (0.4% and 0%, respectively). In another study comparing three puncture sites (radial, brachial, and femoral), the brachial puncture site had the highest risk of developing a large hematoma (0.7%, 4.4%, and 1.5%, respectively) or PSA (0%, 1.3%, and 0%, respectively) [ 10 ].…”

“…The etiology of PSA is multifactorial. The site of the puncture, size of the sheath inserted, complexity and length of the procedure, and anticoagulant therapy applied, among others, are known to play a role in the formation of PSA [4,[8][9][10]. Patients with PSA can be either asymptomatic or symptomatic [7].…”

Delayed severe median nerve palsy due to undiagnosed brachial pseudoaneurysm

“…Non-iatrogenic causes can be infections, inflammatory vascular disease and elastic tissue disorders. Brachial artery catheterization presents a higher incidence of iatrogenic PA compared with femoral or radial accesses [4]. Therefore, radial puncture should be preferred as often as possible.…”

“…Therefore, radial puncture should be preferred as often as possible. Neurological complications and surgical procedures are more frequent in brachial artery PA than in other localisations [4]. In order to limit complications, the site of the arterial puncture must be carefully evaluated.…”