Management of brachial artery thrombosis post catheterization

Brachial artery occlusion is a documented complication after catheterization procedures performed via the brachial artery. These are mainly managed conservatively or with surgical thrombo-embolectomy. We present a case with acute brachial artery occlusion successfully managed with balloon angioplasty and thrombolytic therapy.

A 68-year-old African-American female with a history of aorto-bi-iliac bypass graft presented with acute right upper extremity pain and discoloration after undergoing peripheral catheterization via right brachial artery. We performed emergency angioplasty with lesion reduction from 100% to less than 20% with TIMI grade flow improving from 0 preintervention to 3 postintervention. Postprocedure, the patient was kept on heparin infusion for 24 hours and discharged on aspirin and clopidogrel, with instructions to go to the emergency room in case of bleeding.

Acute brachial artery thrombosis is a rare complication post cardiac catheterization. Previously, it was managed with surgical thrombo-embolectomy; however, with advancement of interventional procedures, a more conservative approach is preferred as stated by the 2005 American College of Cardiology/American Heart Association guidelines. We followed these guidelines and performed successful percutaneous balloon angioplasty with tPA administration in our patient. Careful literature search revealed that this is the first published case report dealing with the matter of acute brachial thrombosis post catheterization.