#16 COMPLICATION RATES OF PERCUTANEOUS BRACHIAL ARTERY ACCESS IN
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#16 COMPLICATION RATES OF PERCUTANEOUS BRACHIAL ARTERY ACCESS IN PERIPHERAL VASCULAR ANGIOGRAPHY Peter J. Armstrong, MD, John A. Baxter, MD, David P. Franklin, MD, James R. Elmore, MD, David C. Han, MD Geisinger Medical Center, Danville, PA Objective(s): The brachial artery has traditionally been considered a secondary choice for percutaneous access due to reported increased complication rates compared to femoral access. The brachial artery approach may be advantageous in certain patients with peripheral vascular disease (PVD). This study evaluated the complication rate of percutaneous brachial artery access in patients with PVD undergoing angiography. Methods: A prospectively collected database of 1326 PVD patients undergoing angiography with brachial access between January 1, 1990 and December 31, 1999 was retrospectively reviewed. A vascular surgeon evaluated the puncture site and distal pulses after each angiogram. Every patient received telephone follow-up at 24 hours. To ensure complete data capture, charts of all patients with coded brachial pathology during this time period were also reviewed. Results: 1326 angiograms were performed through a percutaneous brachial artery approach in PVD patients during a 10-year period. A subset of 111 patients had multiple studies (range: 2 to 7) via brachial access without complication. Complication rates were significantly higher in women. Male n=1084 Female n=242 Overall n=1326 Age 65.1±11.4 63.0±13.6 P=NS 64.7±11.8 Thrombosis 3 (0.28%) 3 (1.24%) P<.04 6 (0.45%) Failed Access 0 (0%) 5 (2.1%) P<.001 5 (0.38%) Pseudoaneurysm 4 (0.37%) 0 (0%) P=NS 4 (0.30%) TIA 1 (0.09%) 0 (0%) P=NS 1 (0.075%) Hematoma 1 (0.09%) 0 (0%) P=NS 1 (0.075%) Conclusions: Percutaneous angiography via the brachial approach can be safely and repetitively performed in patients with PVD. There is an increased risk of thrombosis and failed access in women, which may make the femoral approach preferable. The brachial approach allows early ambulation and discharge, and can be considered as a primary choice for angiographic access.