Selective catheterization of the brachiocephalic arteries via the right brachial artery.

Selective intra-arterial digital subtraction angiography of the brachiocephalic arteries using the right brachial artery approach was successfully performed for 169 of 173 patients, 33 of whom were outpatients. Catheterization was unsuccessful for four patients; two of them elderly hypertensive men with tortuous brachial arteries, and two of them middle-aged obese women for whom arterial puncture could not be performed. 4-F modified Simmons type catheters were used in this study. Selective catheterizations of both common carotid arteries were successfully performed in all but one patient, a woman whose aberrant right subclavian artery prevented bilateral common carotid arterial catheterizations. Selective catheterizations of the right vertebral and left subclavian arteries, though relatively difficult, were successfully performed in 84.2% and 93.9% of patients, respectively. The mean examination time for a four-vessel study was 24.3 min. No major complications were encountered. Thus, transbrachial selective catheterization of the brachiocephalic arteries proved to be safe, useful, and relatively easy to perform.