Single-Stage Endovascular Treatment of Combined Iliac and Infrainguinal Peripheral Arterial Disease Through Brachial Access.

BACKGROUND: Combined inflow and outflow disease has become a common pattern in patients with chronic limb-threatening ischemia. Patients with tissue loss require simultaneous correction of inflow and outflow disease to prevent amputation. However, those patients are usually unfit for open surgical or hybrid procedures due to having multiple comorbidities. The aim of this study was to evaluate the safety and effectiveness of combined iliac and infrainguinal endovascular revascularization via brachial access in a single session.

METHODS: A prospective study conducted on 45 patients with tissue loss. In case of failure to cross the infrainguinal lesions, a secondary femoral access was used.

RESULTS: Technical success was achieved in 75.6% of the patients using brachial access alone and in 20% using secondary femoral access. Only one patient required right brachial access (2.2%), while the remaining 44 patients were treated via left brachial access. Access complications were recorded in 11.1% but only 4.4% required surgical repair of brachial artery. No perioperative mortality and no cerebrovascular events were recorded. At 1 year, the overall and amputation-free survival rates were 93.33% and 84.4%, respectively. Crural artery occlusion was significantly associated with failure of brachial access (P < 0.001). Brachial access-related complications were significantly associated with using larger (7 Fr) sheaths (P = 0.019).

CONCLUSION: Endovascular treatment of combined iliac and infrainguinal disease can be safely delivered via brachial access. Patients with crural artery occlusion may need secondary femoral access to successfully restore direct blood flow to the foot. Higher rate of access complications was associated with using larger arterial sheaths.