Brachial access is a reliable and effective option for treatment of peripheral vascular disease and should be considered when femoral access is difficult or contraindicated and when a bypass graft is present in the femoral region. In addition, bilateral lesions may be approached easily through one brachial artery access site, making this approach advantageous when bilateral lesions are expected. The complication rate is similar to femoral access and can be minimized with ultrasound-guided access distally over the humerus, micropuncture access, and a dedicated postprocedure "hold team."

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Objective: Open or endovascular revascularization is often performed to improve postoperative outcomes in patients undergoing above-knee amputations (AKAs). A lack of data on this practice calls for further investigation. This study details a multicenter experience with AKA with and without preceding vascular interventions to investigate their effectiveness in improving outcomes. Major morbidity and mortality were compared to formulate guidelines for patients in need of an AKA with atherosclerotic disease. Methods: A retrospective cohort review from the Healthcare Cost and Utilization Project State Inpatient Databases in Florida, California, Iowa, and New York from 2007 to 2012 was performed. There were 7611 patients (without intervention, n ¼ 7435; with intervention, n ¼ 176) who underwent AKA for atherosclerotic disease with a 1-year follow-up selected. The population of patients was divided into two groups, those with and those without same-day open or endovascular interventions. Patients with non-same-day interventions were excluded. Primary outcome was composite outcome of either postoperative stump complications or stump revisions. Results: The mean age for patients with concurrent intervention was younger (67.3 vs 73.9 years; P < .001), whereas comorbid disease severity was similar across both groups (P ¼ .516). No significant difference in primary outcomes between groups (16.6% AKA without concurrent intervention vs 18.8% AKA with concurrent intervention; P ¼ .449) was noted. Patients with concurrent intervention were at elevated risk for development of postoperative (odds ratio, 2.24 [1.38-3.64]) and 30-day pulmonary complications (2.29 [1.50-3.50]). No significant difference was seen in postoperative or 30-day surgical site infection, myocardial infarction, or acute renal failure (all P > .05). Notably, length of stay was increased in patients with concurrent intervention (12.4 days vs 9.3 days; P ¼ .007), whereas the odds of being discharged home was decreased in this group (odds ratio, 0.62 [0.40-0.97]). Conclusions: Concurrent vascular intervention with AKA does not significantly improve rate of stump complications or need for stump revisions. In addition, patients are at increased risk of pulmonary complications and increased length of stay. Therefore, it is imperative to weigh the risks and benefits of concurrent vascular intervention in patients with significant atherosclerotic disease undergoing AKA.