Percutaneous entry of the brachial artery using a sheath system has been attempted in 223 patients undergoing left heart catheterization; successfully, in 212. After arterial puncture, a dilator and sheath are passed over a short guidewire. A number 7-80 cm Sones specially stiffened coronary catheter is passed through the sheath, and left heart catheterization is performed in the usual manner. The study can usually be completed with this single catheter. Initial entry, as well as any needed catheter change, is facilitated by the use of an inflatable sphygmomanometer cuff around the upper arm. Ease of manipulation and patient comfort have been satisfactory, and brachial artery spasm has not been encountered. There have been no major complications and a low incidence (approximately 15%) of brachial arterial occlusion.

Angioplasty is most commonly performed with catheters introduced percutaneously into the femoral artery. A brachial approach has previously been described that employs arteriotomy and cutdown. We describe here the technique and initial results of an alternative method of brachial entry, wherein the catheter is introduced percutaneously. Angioplasty has been performed in 26 patients in this manner, without complications.

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