Efficacy and Safety of Percutaneous Brachial Access for [Trans-Atlantic Inter-society Consensus II C and D] Aortoiliac Occlusive Lesions – A Tertiary Care Center Experience

Background: Endovascular interventions for complex aortoiliac occlusive disease, classified under Trans-Atlantic Inter-Society Consensus (TASC) II C and D lesions, have seen remarkable improvements in success rates due to advances in percutaneous techniques. However, lesion crossing remains a key technical challenge. Brachial access can play an important role in lesion crossing in the presence of severe aortoiliac disease. In our study, we will be describing the efficacy and safety of lesion crossing primary by percutaneous brachial access. Materials and Methods: This single-center study analyzed both prospective and retrospective data from 68 patients who underwent endovascular treatment for TASC II C and D aortoiliac occlusive lesions between January 2022 and December 2023. Clinical, demographic, procedural, and follow-up data were systematically collected. The primary outcome assessed was procedural success, defined as successful lesion crossing, with secondary outcomes including access site complications and procedural safety. Results: The study population comprised 67 males and 1 female, with a mean age of 53.7 ± 11.81 years. Most patients were smokers (82%), and a significant proportion had comorbid conditions such as dyslipidemia (54%), Type 2 diabetes mellitus (56%), and hypertension (59%). According to TASC guidelines, 17 patients had TASC C lesions, while 51 had TASC D lesions. Brachial access alone achieved lesion crossing in 59 patients (87%), and combined brachial and femoral access achieved overall procedural success in 63 patients (93%). Manual compression was given after sheath removal at the brachial access site for all patients. Procedural complications included two cases of iliac artery dissection and plaque shift to the opposite iliac artery, which was jailed with a stent. Access site complications were minimal, with minor being 4.4% and major 1.4%, with two cases of brachial artery pseudoaneurysm, one of which required surgical repair, and two cases of hematoma that resolved with conservative management. No central nervous system events were reported. Conclusions: Brachial artery access is a safe and effective option for crossing complex aortoiliac occlusive lesions, offering improved precision in entering the true lumen while minimizing complications associated with subintimal wire manipulation. Access site complications were infrequent and manageable, making brachial access a valuable adjunct in the treatment of advanced aortoiliac disease.