Outpatient transbrachial arterial DSA using a 4F catheter for the clarification of extracranial vascular processes

Experience with intravenous digital subtraction angiography (DSA) has proven disappointing in the outpatient evaluation of cerebrovascular disease. Variations in cardiac output, vessel superimposition, patient motion and poor vascular opacification frequently combine to produce nondiagnostic examinations. To assess the safety of nonselective intra-arterial DSA performed from a brachial artery approach, the complications of 103 examinations, most of which (85%) were performed on outpatients, were prospectively studied. The injection of contrast material into the aorta was made through a 4F multiple side-hole pigtail catheter, inserted percutaneously from the brachial artery. Images were good or excellent in nearly all cases. No permanent neurovascular complications or local artery complications such as thrombosis requiring surgery were encountered and only a few minor complications occurred. We believe that transbrachial intraarterial DSA is a safe, simple and well-tolerated out-patient procedure that can yield reliable, definitive, and complete cerebrovascular studies in nearly all patients referred for the examination.