Angiographic evaluation of right upper-limb arterial anomalies: implications for transradial coronary interventions.
OBJECTIVE
Upper-limb arterial anomalies are sometimes encountered during transradial coronary procedures. These anomalies may contribute to procedural failure or to vascular complications, and are a major reason why many operators tend to avoid transradial procedures. We investigated the frequency of right upperlimb arterial anomalies using antegrade arteriography in patients undergoing transbrachial coronary angiography or intervention, and discuss the potential impact of these anomalies on the transradial procedure.


METHODS
We prospectively studied 163 consecutive patients who underwent right transbrachial coronary angiography or intervention for the first time during the period from May 2007 to December 2007. Following the transbrachial procedure, we performed antegrade transbrachial arteriography of right upper-limb arteries in these patients and investigated the frequency and anatomy of arterial anomalies.


RESULTS
A total of 40 upper-limb arterial anomalies were observed in 38 patients (23.3%). These included 8 abnormal origins (4.9%), 2 radio-ulnar loops (1.2%), 25 tortuosities (15.3%), 4 stenoses (2.5%) and 1 loop (0.6%). In patients with congenital lesions (8 patients; 4.9%), abnormal origin of the radial artery was the most common anomaly encountered, and in the acquired group (25 patients; 15.3%), tortuosity was the most common abnormality.


CONCLUSIONS
Even with a 23.3% incidence of right upper-limb arterial abnormalities, 98.8% of patients were acceptable for transradial coronary intervention except for 1.2% of radio-ulnar loops.
Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Toshiharu
T
Fujii
Naoki
N
Masuda
Seiji
S
Tamiya
Makiyoshi
M
Shima
Eri
E
Toda
Daiki
D
Ito
Gaku
G
Nakazawa
Takashi
T
Matsukage
Nobuhiko
N
Ogata
Yoshihiro
Y
Morino
Teruhisa
T
Tanabe
Yuji
Y
Ikari
D000368:Aged; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging*