#16 COMPLICATION RATES OF PERCUTANEOUS BRACHIAL ARTERY ACCESS IN

							#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.