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Occasional-operator percutaneous brachial coronary angiography: first, do no arm
David J R Hildick-Smith1, Zafar I Khan, Leonard M Shapiro
1Department of Cardiology, Papworth Hospital, Cambridgeshire, UK. david.hildick-smith@bsuh.nhs.uk
Summary
Percutaneous brachial coronary angiography by occasional operators is hazardous, with a 36% complication rate. High-volume experience in brachial or radial approaches is recommended for patient safety.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous brachial approach for coronary angiography is considered simpler than other arm approaches.
- Operators primarily using the femoral technique may be tempted to use the brachial approach occasionally.
Purpose of the Study:
- To prospectively evaluate the safety and outcomes of percutaneous brachial cardiac catheterization performed by infrequent brachial operators.
- To determine if occasional use of the percutaneous brachial approach is a reasonable strategy.
Main Methods:
- Prospective study of 55 patients undergoing percutaneous brachial coronary angiography between October 1997 and 2000.
- Analysis of procedural success rates, reasons for failure, and complication types and severity.
Main Results:
- Procedure success rate was 84% (46/55 patients).
- Complications occurred in 36% (20/55) of patients, including major events like false aneurysms and hematomas requiring surgical repair.
- Indications included peripheral vascular disease (64%) and failed femoral access (18%).
Conclusions:
- Percutaneous brachial coronary angiography by occasional operators is associated with unacceptably high complication rates.
- Patient outcomes suggest that high-volume experience is crucial for minimizing risks.
- Referral to high-volume brachial or radial experienced operators is advised for patients needing an arm approach.