Role of brachial artery ligation as an emergency procedure in bleeding arteriovenous access AR Chandrashekhar, Luv Luthra, Sanjay C Desai, B Rajendra Prasad Indian Journal of Vascular and Endovascular Surgery 2019 6(2):99-101 Introduction: Bleeding from a ruptured or infected arteriovenous (AV) access is a life-threatening situation leading to increased mortality in chronic kidney disease (CKD) patients. All these patients need emergent and expeditious management. The procedures described for bleeding complications in AV access are associated with high morbidity and mortality. In some cases, there is a need for a major surgery or bypass. Aim: The aim was to evaluate the safety and efficacy of brachial artery ligation (BAL) in bleeding AV access. Materials and Methods: This was a single-center retrospective analysis of 106 patients who underwent BAL for bleeding AV access (AV graft [AVG]/brachiocephalic [BC] AV fistula [AVF]) from January 2007 to 2017. Results: During this study period, BAL was done in a total of 106 patients, out of which 51 patients underwent AVG explantation with BA ligation and 55 with ligation in BC fistulas. There were 73 males and 33 females with a mean age of 45 years (11–90). The primary etiology was hypertension (66%), diabetes (23.58%), and other causes (10.3%). Twenty patients presented with acute bleeding due to graft erosion and 31 patients had purulent discharge from puncture site with sepsis. Infection was involving anastomosis in all patients. Out of 55 patients who underwent AVF, 5 patients had infection at puncture site 3–4 cm near the anastomosis. Fifty patients had infected pseudoaneurysms at the anastomotic site that developed within 1 week of the creation of fistula. All patients were evaluated and assessed for signs of ischemia in the postoperative period till the time of discharge. Conclusion: BAL is a safe alternative in patients with access site bleeding as it reduces not only the operative time but also the morbidity and mortality associated with CKD patients. Ligation of the brachial artery at the elbow can be used as a primary approach in complicated vascular access.