Safety and efficacy of percutaneous entry of the brachial artery versus cutdown and arteriotomy for left-sided cardiac catheterization

The standard approach to left-sided cardiac catheterization from the arm has been by cutdown and brachial arteriotomy (C and A). 1 In 1981, Fergusson and Kamada 2 described a method for left-sided cardiac catheterization by percutaneous entry (PE) of the brachial artery. Since this initial description, several developments have occurred: (1) More patients are returning for repeat cardiac catheterization after coronary artery bypass surgery or transluminal coronary angioplasty. (2) Patients often prefer to undergo the procedure as outpatients, reducing the cost of their procedure. (3) Technical improvements in arteriography catheters allow smaller catheters to be used without compromising flow rates during injection or torque control. (4) Certain investigators suggest that procedure time may be shorter with PE of the brachial artery. 3 In view of these developments, PE has become a more attractive alternative to the standard C and A. To assess the safety and efficacy of PE vs C and A, we retrospectively reviewed our experience with both approaches to left-sided cardiac catheterization at the Mount Sinai Hospital.