title: Analysis of peripheral arterial bends that interfere with coronary catheterization.
abstract: OBJECTIVE
  The aim of this study was to analyze the characteristics of peripheral arterial bends that interfere with coronary catheterization.
  
  
  BACKGROUND
  Complex aortic and peripheral arterial bends are important factors in unsuccessful coronary catheterization. Methods.We classified peripheral arterial bends based on the difficulty of coronary catheterization: no bend, type A: easy; type B1: difficult but possible; type B2: difficult but possible with assistance of a device such as a long sheath; type C: impossible. We analyzed 1,626 consecutive cardiac catheterizations.
  
  
  RESULTS
  Reproducibility (+/- 1 grade) was 98.9% in 256 patients undergoing multiple procedures from the same approach site. Peripheral arterial bend class distribution was as follows: no bend: 76.4%, type A: 12.5%, type B1: 5.0%, type B2: 5.5%, and type C: 0.6%. Fluoroscopy time and contrast volume were significantly greater in type B2/C (9.6 +/- 6.26 min versus 13.8 +/- 8.9 min, p < 0.0001 and 142.0 +/- 38.8 ml versus 168.4 +/- 53.6 ml, p < 0.0001, respectively). There were no differences in the distribution of types B and C by approach site; femoral approach, 6.4%% right upper limb approach, 6.1%; and left upper limb approach, 5.0%. Furthermore, in the patients who underwent multiple catheterizations from different approach sites, the arterial bend classes were similar. Predictors of a type B2/C arterial bend were mainly atherosclerotic risk factors, suggesting that longitudinal arterial elongation is the major cause of arterial bends.
  
  
  CONCLUSIONS
  Peripheral arterial bends are a feature of the individual patient, not of the approach site.
authors.affiliation: Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Masuda
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsukage
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Ogata
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Morino
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Tanabe
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ikari
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001011:Aorta / Q000473:pathology; D001916:Brachial Artery; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005263:Femoral Artery; D005471:Fluoroscopy / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017534:Radial Artery; D012307:Risk Factors; D013997:Time Factors