For over 20 years, we have been using the transbrachial approach as the first-line option for abdominal angiography and transcatheter arterial chemoembolization (TACE). The present study involving 6262 patients (success rate of 99.8%) showed that the transbrachial approach could be used for superselective angiography or computed tomography during angiography (angio-CT) and was effective for hemostasis of abdominal aneurysmal hemorrhage, diverticular hemorrhage and partial splenic embolization. The approach was highly safe with no association with serious complications. Bleeding from the puncture site was reported in 225 cases (0.36%), numbness due to nerve damage at the puncture site. was reported in 376 cases (0.6%), and arteriovenous fistula in the puncture site was reported in 84 cases (0.13%). In the treatment of hepatic disease, the guiding catheter could be inserted deeper into the hepatic artery, and hemostasis after sheath removal required shorter time compared with the transfemoral approach. Based on its safety and usefulness, transbrachial angiography and intervention therapy is a first-line treatment for abdominal diseases.