I installed the ATT without removing the wheel or fender. Just stubby wrenches in some places and long narrow wrenches in others. I have a lot of different wrench types and maybe less stuff in the way on my 94.
If you are getting the ATT you better upgrade to 4" exhaust. My ATT did nothing with the Banks 3.5" exhaust with Cat on it. Whereas my GM4 would perform just great. I put 4" straight pipe on and ATT spins up so fast and boosts to 12psi no problem on empty acceleration. I added a chambered muffler and lost a few psi boost. That was just because straight pipe was killing my own ears and neighbors mustnt have been happy. Got the 4" muffler free anyway, was for a Cat Tractor. I have a 5" straight through muflfer I am adapting on next week.
Anyway, 3" exhaust probably isnt going to cut it, so add a few hundred to the list for exhaust when getting ATT. I wonder what the GM4 would have been like with this 4" exhaust, if I fell into a TM for it maybe I'd test that, but not hooking up the vac pump.
Driving at high elevations also threw my ATT for a bit of a loop, good amount of black smoke, even after the exhaust upgrade. Before the exhaust upgrade it couldnt even climb in OD over 40mph up the mountains, any time I tapped accelerator long trails of thick black smoke had to trail the big rigs in 3rd gear at 40mph to prevent the smoke and high EGTs (im talking only above a mile high). After 4" exhaust I was good to maintaining speed at 75mph no problems, with AC on, only bad smoke when getting up to speed. My PCM might not have been compensating for high elevation correctly, but I tried running stock PCM too and no better.
I also have WMI and Propane on mine, the propane I got some power out of it, but the expense is probably only for serious pullers. sometimes the truck would just take off up the mountains with the cruise at 70mph it would go to 90mph from turning on the WMI and propane. I then fixed my solenoids where my Hobbs pressure switches had fried to always closed. The WMI is great though, I would watch GMTDScan IATs fall big time when I switched on the WMI while climbing the mountains.
I have also noticed much lower exhaust backpressure from ATT as discussed in other posts. My ATT whistles so loud I have had more people come and ask me whats under the hood than ever before.
So exhaust would be my first upgrade, then reflash, but if you already bought the ATT, Im sure justification for those two wont be far behind anyway.