title: Impact of radial-to-aorta vascular anatomical variants on risk of failure in trans-radial coronary procedures.
abstract: OBJECTIVE
  To assess the impact of an "operative" classification of vascular anatomic variants on the feasibility of trans-radial approach.
  
  
  BACKGROUND
  Vascular anatomic variants located from the wrist to the aorta may influence the feasibility of trans-radial procedures. Recently, a new "operative" classification of these variants was proposed.
  
  
  METHODS
  Consecutive trans-radial diagnostic or interventional catheterizations were considered. Vascular anatomic variants were classified according to 10 categories and sub-grouped according to the ABC classification (A: radial-brachial arterial axis; B: axillary-subclavian-anonymous axis; C: aortic arch). Primary study end-point was failure of trans-radial approach (necessity to cross-over to another approach to complete the procedure).
  
  
  RESULTS
  Three thousand four hundred seventy-seven consecutive radial procedures were considered. Anatomic variants were diagnosed in 308 procedures (8.8%): A variants: 7.2%, B variants: 1.9%; C variants: 0.3%. Failure occurred in 2.0% of procedures. Failure rate was 0.7% in the absence of variants vs.15.2% in the presence of any variant (P < 0.0001, OR 27.7, 95%CI 16.3-46.9). Each of the 10 variants was significantly associated with increased failure rate. Each of the three level-subgroups of variants was significantly associated to the risk of failure (failure 14.7% in A level, 13.9% in B level, 33.3% in C level; P < 0.0001 vs. absence of variants).
  
  
  CONCLUSIONS
  Failure of trans-radial procedures is associated to anatomic variants located from the wrist to the aorta. The "operative" ABC classification of anatomic variants is useful not only to categorize these anatomic variants, but also to predict the risk of failure of trans-radial approach.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. f.burzotta@rm.unicatt.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Marta Francesca
authors.initials: MF
authors.lastname: Brancati
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Antonella
authors.initials: A
authors.lastname: Tommasino
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Valentina
authors.initials: V
authors.lastname: Coluccia
authors.forename: Paola
authors.initials: P
authors.lastname: Di Noi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D001011:Aorta / Q000002:abnormalities*; D001027:Aortography; D001366:Axillary Artery / Q000002:abnormalities; D001916:Brachial Artery / Q000002:abnormalities; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods*; D011237:Predictive Value of Tests; D017534:Radial Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012307:Risk Factors; D013348:Subclavian Artery / Q000002:abnormalities; D017211:Treatment Failure; D054079:Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging