title: Complications of lower-extremity outpatient arteriography via low brachial artery.
abstract: We retrospectively evaluated low brachial artery puncture for arteriography and its complications as an alternative approach route for bilateral lower extremity run-off. Using the Seldinger technique and catheterization with a sheathless 4-F multiple side-hole pigtail catheter, we performed 2250 low brachial artery punctures in outpatients. The right brachial artery (RBA) was successfully punctured in 2039 patients; the left brachial artery (LBA) in 200. The transfemoral approach was used in 11 patients when catheterizing either of brachial arteries failed. Ten major or moderate complications (2 pseudoaneurysms, 2 thrombosis, 1 dissection and 5 hematomas) were encountered. Surgical intervention was necessary in three cases. There were no transient ischemic attacks. Twenty-one patients suffered temporary loss of radial pulse which returned spontaneously in less than 1 hour. One patient demonstrated prolonged loss of pulse which required heparin. Low brachial artery puncture and catheterization at the antecubital fossa is a very safe and cost-effective alternative to the femoral artery approach for lower extremity intra-arterial arteriography in the hands of experienced operators. The success rate in catheterizing one of the brachial arteries was 99.52% with a low significant complications rate of 0.44%. The transbrachial approach should be used as a standard method for lower extremity IA-DSA in an outpatient setting.
authors.affiliation: Department of Radiology, Areteion Hospital, University of Athens, Athens, Greece. ahatzi@cc.uoa.gr
authors.forename: A
authors.initials: A
authors.lastname: Chatziioannou
authors.forename: C
authors.initials: C
authors.lastname: Ladopoulos
authors.forename: D
authors.initials: D
authors.lastname: Mourikis
authors.forename: K
authors.initials: K
authors.lastname: Katsenis
authors.forename: G
authors.initials: G
authors.lastname: Spanomihos
authors.forename: L
authors.initials: L
authors.lastname: Vlachos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology; D000792:Angiography; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D011677:Punctures / Q000009:adverse effects; D012189:Retrospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D017211:Treatment Failure