First Report of Hybrid Brachial Artery Access Enabling Complex Coronary Intervention

When both radial and femoral arteries are unusable, securing arterial access for percutaneous coronary intervention (PCI) becomes a critical barrier, particularly in patients requiring complete revascularization before major surgery. Isolated reports describe surgical exposure of axillary or carotid arteries to facilitate PCI in extreme peripheral arterial disease, demonstrating that hybrid access can be safe and technically effective. We describe a case where surgical brachial artery exposure enabled stable 7 Fr access for complex PCI in a patient with Leriche syndrome and complete bilateral occlusion of both the forearm and iliofemoral arteries. Multivessel and left main bifurcation PCI were completed successfully, with vascular surgeons ensuring precise arterial exposure and secure closure. This case presents a rarely reported hybrid brachial surgical-percutaneous access allowing large-bore PCI when no conventional access site is available. Hybrid brachial surgical access can expand PCI feasibility in otherwise impossible cases. Vascular-interventional collaboration is key to success in extreme-access situations.