Transbrachial thrombolysis, PTA and stenting in the lower extremities

We present an analysis of 37 interventions in the arteries of the lower limbs via a transbrachial arterial approach. Twenty-six patients (42-79 years) underwent 37 interventional procedures in the lower extremities (iliac n = 6, iliac + femoro-popliteal n = 1, femoro-popliteal n = 30) with a vascular approach via the brachial artery (33 left sided, 4 right sided, introducer sheath 4-7 F). The transbrachial approach was chosen to avoid puncture of femoral bypass graft material. Technical success could be achieved in 11/13 thrombolyses, 8/9 PTAs, 7/10 combinations of thrombolysis and percutaneous transluminar angioplasty (PTA) and in the placement of two stents. One patient suffered from periprocedural severe re-thrombosis due to insufficient anticoagulation during fibrinolysis, and twice thrombolysis was incomplete. One puncture-related false aneurysm of the brachial artery had to be corrected surgically. One transient ischemic attack (TIA) and four minor complications occurred. Transbrachial vascular approach for arterial interventions in iliac and femoro-popliteal pathologies is a reasonable alternative to the transaxillary access if transfemoral puncture has to be avoided. The technical success rate is comparable with the results of the transaxillary and transfemoral approach. To minimize, at least theoretically, the risk of cerebral complications, the left-sided approach should be preferred and intravenous heparin should be administered routinely.