SURGICAL COMPLICATIONS OF TRANSAXILLARY ARTERIOGRAPHY - A CASE-CONTROL STUDY

Purpose: The purpose of this study was to review the complications of transaxillary arteriography (TRAX), determine clinical factors associa ted with their occurrence, and define optimal treatment methods. Metho ds: A retrospective review of 842 consecutive TRAX studies performed i n a large, urban, tertiary care, academic medical center was undertake n. Patients with complications were compared with a concurrent randomi zed control group without complications with the use of a multivariate analysis model. Results of operative therapy for nerve injury were co mpared with those of nonoperative therapy. Results: Nineteen (2.3%) co mplications were identified including 14 nerve injuries, four expandin g hematomas/pseudoaneurysms without neurological deficit, and one punc ture site thrombosis. Several statistically significant or suggestive findings associated with the occurrence of complications were identifi ed: female sex (odd ratio [OR]=4.7), systolic blood pressure greater t han or equal to 150 mm Hg at the conclusion of TRAX (OR=9.5), periproc edural systemic heparin anticoagulation (OR=7.9), concomitant use of i ntraarterial thrombolysis or percutaneous angioplasty (OR=12.0), and d uration of procedure greater than or equal to 90 minutes (OR=4.0). Pat ients who underwent prompt exploration (lass than or equal to 4 hours from symptom onset) for nerve injuries were more likely to have comple te resolution of their neurologic deficits (five of six patients) than those who were observed or underwent delayed operation (three of eigh t patients) (OR=8.3) Conclusion: Aggressive treatment of post-TRAX hyp ertension, limitation of TRAX duration, delay of postprocedure anticoa gulation, and use of alternative sites for arterial puncture in female patients or patients undergoing catheter-based intervention may reduc e the incidence of TRAX-related complications. In patients who have ne urologic deficits prompt surgical exploration of the puncture site wit h the decompression of the involved nerve(s) may reduce the incidence of prolonged deficits.