SUBCLAVIAN ARTERY CATHETERIZATION - A NEW APPROACH FOR ENDOVASCULAR PROCEDURES

Purpose: Percutaneous access to the arterial system for endovascular p rocedures is usually achieved through the femoral arteries. When femor al access is precluded, the axillary or brachial arteries serve as alt ernatives. Complications associated with the use of the latter arterie s have led us to develop subclavian arterial catheterization. Methods and Results: From 1978 to 1993, 569 patients underwent angiography via the subclavian artery (>99% left subclavian artery); 134 were studies of the aortic arch and brachiocephalic vessels; 435 studies involved the descending and abdominal aorta and its branches and runoff. Corona ry arteriography was also feasible. Since 1986, 44 patients have under gone endovascular procedures: 33 percutaneous transluminal angioplasti es of the visceral, iliac, femoral, and popliteal arteries and 11 thro mbolytic procedures of aortofemoral graft limbs (n = 3) and femoral di stal bypasses (n = 8) were performed. Complications (1.2%) included pa rtial pneumothorax (n = 2), hemorrhage requiring operative control (n = 2), causalgia (n = 1) and embolization (n = 2). Conclusions: Wheneve r percutaneous femoral catheterization cannot be achieved or an altern ate access point is indicated, we select the subclavian approach as an alternative to axillary, brachial or translumbar access. It is safe, expeditious, and versatile for virtually all types of systemic and car diac catheterization; it is also applicable to thrombolysis and balloo n angioplasty.