PTA of right brachial artery

Clinical History

Successful PTA of brachial arterial stenosis

Imaging Findings

The patient presented with claudication of her left arm during exercise. Transfemoral angiography revealed mild atherosclerotic changes in her general vascular system but a tight stenosis of the brachial artery distally to the humeral head (Fig. 1). After passing the lesion by means of a 4 F headhunter shaped catheter and a 260 cm long 0.035 in coated guidewire, the lesion was dilated with a 4 mm wide 4 cm long balloon catheter on a 120 cm long shaft (Smash, BSIC) for 45 seconds. After removal of the balloon, a 6 F guiding catheter was inserted into the subclavian artery to image the postangioplasty result (Fig. 2). After proving sufficient patency, the intervention was terminated.

Discussion

Atherosclerotic brachial stenoses are relatively rare. Indication for treatment is brachial claudication. The lesions can be attacked either by a transfemoral or transbrachial retrograde approach. Advantage of transfemoral approach is easiness of access to the brachial artery via large access arteries. Disadvantage, however, is the long distance which requires special legths of guidewires and catheters and sometimes problems of reduced power to the catheter´s tip. Transbrachial approach would be another option. However, reduced or absent brachial pulse may complicate safe puncture of the artery. The small diameter of the brachial artery reduces the maximum diameter of access sheaths which means use of small caliber balloons and wires. In very special situations, a pull-through techniques may be used especially in tight lesions to give more strength on guidewires and catheters. Then, a guidewire is fixed on both ends by a transfemoral and transbrachial access.

Differential Diagnosis List

Final Diagnosis

Successful PTA of left brachial artery

URL:	https://www.eurorad.org/case/492
DOI:	10.1594/EURORAD/CASE.492
ISSN:	1563-4086