Occasional‐operator percutaneous brachial coronary angiography: First, do no arm

Abstract

The percutaneous brachial approach to coronary angiography is perceived, rightly or wrongly, to be the easiest of the arm approaches. Predominantly femoral operators may therefore be encouraged to use the percutaneous brachial approach as an occasional procedure. We decided to investigate prospectively whether this was a reasonable strategy by examining outcome in patients who underwent percutaneous brachial cardiac catheterization by occasional brachial operators. Between October 1997 and 2000, 55 patients underwent percutaneous brachial coronary angiography (0.6% of coronary angiographies), aged 66 +/- 10 years, of whom 40 (73%) were male. Chief indications for a brachial approach were peripheral vascular disease in 35 (64%), failed femoral approach in 10 (18%), and orthopnoea in 5 (9%). The procedure was completed successfully in 46 patients (84%). Reasons for failure were failure of access (two), brachial artery spasm (one), inability to negotiate brachial/subclavian tortuosity (two), dissection of the brachial artery (two), and inability to intubate a vein graft (two). Six patients required catheterization from an alternative site (brachial arteriotomy in two, percutaneous transradial in two, femoral in two), with success in all. There were complications of varying severity in 20 patients (36%). Major complications were false aneurysm requiring surgical repair (one), large brachial hematoma requiring surgical exploration and arterial repair (one), and hematoma with clinical median nerve dysfunction for one month. Minor complications included need for repeat coronary angiography via alternative approach (six), weakness of radial pulse < 24 hr (two), brachial artery dissection without clinical sequelae (two), brachial artery spasm terminating procedure (one), and wound oozing (three). Percutaneous brachial coronary angiography is a hazardous procedure when undertaken by occasional brachial operators. Complications are unacceptably frequent. As with all practical procedures, complication rates are likely to be inversely proportional to operator volumes. Patients requiring an arm approach should be referred to operators with high-volume brachial or radial experience.

Transradial coronary angiography in patients with contraindications to the femoral approach: An analysis of 500 cases

“…The radial approach is a quicker procedure with comparable success rates [26] that has therefore superseded the brachial cut‐down in most catheter laboratories. The percutaneous brachial approach has been championed by some operators [27], but is a procedure with a significant risk of complications [28, 29], particularly if undertaken only occasionally [30]. Axillary approaches [31, 32] have gradually gone out of favor.…”

Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI

“…The first is a pharmacological strategy [13, 26–30], the second is optimizing femoral access [31–35], and the third is avoiding the femoral artery altogether. Although brachial access exists as an alternative [36–45], the radial artery has become the preferred choice for upper extremity arterial access due to its easy compressibility, distance from major veins and nerves, and companion blood flow through the ulnar artery to the palmar arch.…”

Transradial Intervention of Iliac and Superficial Femoral Artery Disease is Feasible

“…Although lower‐extremity interventions via the brachial artery approach have been reported, 5 use of this access site could be complicated by false aneurysms or brachial hematomas with median nerve compression and may require surgical exploration and repair 6 . Bleeding complications in transfemoral intervention have been reported in up to 7% of cases.…”