The brachial artery has been considered a secondary choice for percutaneous access due to reported increased complication rates compared to femoral access despite potential advantages in peripheral vascular disease (PVD) patients. A prospectively collected database of 1326 PVD patients undergoing angiography with percutaneous brachial access between January 1, 1990 and December 31, 1999 was retrospectively reviewed. All patient charts with coded brachial pathology during this time period were reviewed to ensure complete data capture. The protocol for patients undergoing brachial access included a vascular surgery evaluation after each angiogram and telephone follow-up by a nurse at 24 hr. During this 10-year period, a percutaneous brachial artery approach was used to perform 1084 angiograms in men and 242 angiograms in women. A subset of 111 patients had multiple studies (range: 2 to 7) via brachial access without complication. Rates of failed access (2.1% female vs. 0% male, p <0.001) and brachial thrombosis (1.24% female vs. 0.28% male, p <0.04) were significantly higher in women. The complication rate for all patients was 1.28%. Percutaneous brachial access for angiography can be safely and repetitively performed in PVD patients, although women have an increased risk of thrombosis and failed access. The brachial approach allows early ambulation and discharge, and can be considered a primary choice for diagnostic angiographic access.