Management of brachial artery occlusion after cardiac catheterization.

Our management of patients with suspected brachial artery injury following cardiac catheterization and the results of operative management in 42 patients are reported. From this review the following suggestions or conclusions are made: 1) The absence of a distal radial pulse or a 30-mm Hg difference in forearm pressures four hours after brachial artery catheterization is indicative of a pathologic occlusion at the site of catheterization. 2) Adequate anticoagulation with heparin should be used during the observation period. 3) When indicated, reexploration of the brachial artery should be performed in the operating room using local anesthesia. 4) Resection of a segment of injured brachial artery with an end-to-end anastomosis using interrupted sutures gives good results. Attempts at "plastic" repair without resection were ususlly accompanied by reobstruction. 5) Arterial pressures in both arms, as monitored with a Doppler instrument before and after exercise, were of value in evaluating these patients pre- and postoperatively. 6) No preoperative arteriograms were required. 7) Restoration of adequate circulation was achieved in 97 per cent of patients operated on for brachial artery injury within 24 hours of cardiac catheterization and using the techniques described. 8) The good operative results and low morbidity suggest early repair for all confirmed brachial artery injuries.