Efficacy and safety of PTCA using brachial approach and low-dose heparin

Percutaneous transluminal coronary angioplasty (PTCA) is routinely performe d using the femoral approach. However, recent reports suggest the usefulnes s of the brachial approaches for patients for whom the femoral approach is impossible due to peripheral vessel disease or to shortened postoperative r est times. However, some reports have revealed that the incidence of vascul ar complications undergoing brachial-approach PTCA may be higher than those with the femoral approach, possibly due to relatively higher dose of hepar in. Accordingly, in this study we evaluated the efficacy and safety of PTCA using the brachial approach and low-dose heparin, hypothesizing that lower ing the heparin dose might result in reduced vascular complications. The st udy population of patients admitted for angina pectoris consisted of 217 su bjects (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 pati ent or lesion characteristics between the groups. Incidence of vascular com plications tended to be lower in the brachial group than in the femoral gro up (1.8% vs. 3.5%), although the difference did not reach statistical signi ficance. 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 a s safe and effective a strategy as compared with the femoral approach with standard dose of heparin. (C) 2001 Wiley-Liss, Inc.