title: Failure of transradial approach during coronary interventions: anatomic considerations.
abstract: The anatomy of the radial artery has yet to be systematically studied from the perspective of using it as a route for catheter access. We prospectively performed angiography of the arteries of the upper limb to delineate the anatomic features of the radial artery as a way to determine the feasibility of using it as a route for coronary intervention. We studied 2,211 consecutive patients submitted to transradial cardiac catheterization. In all patients, an angiography of the upper limb arteries was performed before and after procedure. Radial puncture was successful in 98.9% of patients. At angiography, anatomic variations of upper limb arteries were noted in 505 patients (22.8%) and included tortuous configurations (3.8%), stenosis (1.7%), hypoplasias (7.7%), radioulnar loop (0.8%), abnormal origin of the radial artery (8.3%), and lusoria subclavian artery (0.45%). Overall procedural success by transradial approach was 97.5%. Patients with anatomic variations of radial artery had a significantly lower puncture (96.2% vs 99.7%, P < 0.0001) and procedural (93.1% vs 98.8%, P < 0.0001) success. The procedure was successfully performed by radial approach in 98.8% of patients with tortuous configurations, 91.9% of radial stenosis, 93.9% of hypoplastic radial artery, 83.3% of radioulnar loop, 96.7% of radial axillary origin, and 60% of lusoria subclavian artery setting. Anatomic variations of the radial artery are not rare. However, they do not represent an important limitation in transradial approach if they are well documented previously.
authors.affiliation: Interventional Cath Lab, Cardiovascular Department, Ospedali Riuniti of Bergamo, Italia. ovalsec@tin.it
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.forename: Angelina
authors.initials: A
authors.lastname: Vassileva
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tespili
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Laurian
authors.initials: L
authors.lastname: Mihalcsik
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrazzi
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization / Q000379:methods*; D002406:Catheterization, Peripheral; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D034941:Upper Extremity / Q000098:blood supply*