Brachial artery catheterization to facilitate endovascular grafting of abdominal aortic aneurysm: Safety and rationale

Purpose: Endovascular treatment of abdominal aortic aneurysms (AAAs) is a t echnically demanding procedure that is based on the complexity and multipli city of steps and the guidewire and catheter manipulations required. Brachi al artery catheterization is an adjunctive technique that can facilitate th e placement of an endoluminal prosthesis. Methods: Brachial access was used during endoluminal AAA repair in 79 of 10 3 consecutive patients with a modular-design stent-graft prosthesis at two institutions. Results: Left brachial access facilitated (1) angiography to guide juxtaren al device deployment, (2) antegrade contralateral limb access, (3) device d elivery through disadvantaged iliac arteries by means of a brachial femoral wire, (4) access to renal arteries when necessary, and (5) catheter exchan ges and a reduction in fluoroscopic positional changes. Complications inclu ded one puncture-site pseudoaneurysm, seven hematomas, and 29 patients with extensive ecchymosis. The length of stay was not prolonged in any case. Th ere were no embolic, oculocerebral, or ischemic upper extremity events. Conclusions: Brachial artery catheterization, as an adjunctive technique to endoluminal AAA repair, offers noteworthy technical advantages with few, b ut self-limiting complications.