title: Efficacy and safety of PTCA using brachial approach and low-dose heparin.
abstract: Percutaneous transluminal coronary angioplasty (PTCA) is routinely performed using the femoral approach. However, recent reports suggest the usefulness of the brachial approaches for patients for whom the femoral approach is impossible due to peripheral vessel disease or to shortened postoperative rest times. However, some reports have revealed that the incidence of vascular complications undergoing brachial-approach PTCA may be higher than those with the femoral approach, possibly due to relatively higher dose of heparin. Accordingly, in this study we evaluated the efficacy and safety of PTCA using the brachial approach and low-dose heparin, hypothesizing that lowering the heparin dose might result in reduced vascular complications. The study population of patients admitted for angina pectoris consisted of 217 subjects (221 lesions) who underwent brachial-approach PTCA and 102 subjects (115 lesions) who underwent PTCA via the femoral approach. Both groups were monitored for complications. There were no significant differences in patient or lesion characteristics between the groups. Incidence of vascular complications tended to be lower in the brachial group than in the femoral group (1.8% vs. 3.5%), although the difference did not reach statistical significance. Use of anodynes was also significantly lower in the brachial group (3.6% vs. 33%). PTCA from the brachial approach with low-dose heparin is as safe and effective a strategy as compared with the femoral approach with standard dose of heparin.
authors.affiliation: Department of Cardiology, Baba Memorial Hospital, Sakai, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Taguchi
authors.forename: T
authors.initials: T
authors.lastname: Kawarabayashi
authors.forename: A
authors.initials: A
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Nishida
authors.forename: T
authors.initials: T
authors.lastname: Sakamoto
authors.forename: A
authors.initials: A
authors.lastname: Tahara
authors.forename: K
authors.initials: K
authors.lastname: Shimada
authors.forename: J
authors.initials: J
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use*; D001916:Brachial Artery; D001026:Coronary Artery Bypass; D005260:Female; D005263:Femoral Artery; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D000925:Anticoagulants; D006493:Heparin