The complications of high brachial artery puncture

Fifty-two angiograms via a high brachial puncture were performed in Sheffield from 1986 to 1988 in patients in whom femoral artery catheterization was not possible or was contraindicated. Follow-up was obtained in 49 procedures. The procedure was initially successful in 43 cases. Twelve patients developed haematomas, graded large in 5, but no intervention for haematoma was required. The radial pulse was diminished or absent at the end of examination in four patients; three of these patients had no associated ischaemia, the pulse returning spontaneously within 24 hours, although remaining chronically reduced in one patient. One patient developed ischaemia due to acute occlusion of the brachial artery--this was successfully treated with immediate angioplasty. Paraesthesiae in the median nerve distribution were noted in two patients. These resolved spontaneously and no permanent neurological problem was seen. We conclude that high brachial artery puncture is a useful alternative when femoral artery puncture is not possible.