title: Anatomical variations affect radial artery spasm and procedural achievement of transradial cardiac catheterization.
abstract: Transradial cardiac catheterization (TRCC) has unique technical challenges such as access difficulty related to anatomical variations and/or radial artery (RA) spasm. We sought to evaluate the incidence of anatomical variations of the RA and whether they would affect RA spasm and procedural achievement of TRCC. A total of 744 consecutive patients who underwent TRCC were analyzed by routine radial arteriography. Anatomical variations were defined as abnormal origin of the RA and/or radioulnar loop and/or tortuous configuration. RA spasm was defined as >75 % stenosis at first radial arteriography. Overall, anatomical variations were noted in 68 patients (9.1 %), including 39 cases of abnormal origin (5.2 %), 11 cases of radioulnar loop (1.5 %), and 42 cases of tortuous configuration (5.6 %). Transradial procedures failed in 26 patients (3.5 %), and more frequently in patients with anatomical variation than in those with normal anatomy (23.5 % vs 1.5 %, P < 0.001). Importantly, on multivariate analysis the presence of anatomical variation was a distinct predictor of transradial procedure failure (odds ratio (OR) 17.80; 95 % CI 7.55-43.73; P < 0.001). RA spasm was observed in 83 patients (11.2 %), and more frequently in patients with anatomical variation than in those with normal anatomy (35.3 % vs 8.7 %, P < 0.001). Anatomical variation (OR 4.74; 95 % CI 2.61-8.47; P < 0.001) and female gender (OR 2.23; 95 % CI 1.01-4.73; P = 0.041) were distinct predictors of RA spasm. Anatomical variations were observed in 9.1 % of the patients, and strongly correlated with RA spasm and procedural achievement of TRCC.
authors: Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, numasawa@cpnet.med.keio.ac.jp.
authors: Yohei
authors: Y
authors: Numasawa
authors: Akio
authors: A
authors: Kawamura
authors: Shun
authors: S
authors: Kohsaka
authors: Masashi
authors: M
authors: Takahashi
authors: Ayaka
authors: A
authors: Endo
authors: Takahide
authors: T
authors: Arai
authors: Yohei
authors: Y
authors: Ohno
authors: Shinsuke
authors: S
authors: Yuasa
authors: Yuichiro
authors: Y
authors: Maekawa
authors: Keiichi
authors: K
authors: Fukuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D017534:Radial Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011859:Radiography; D012307:Risk Factors; D013035:Spasm / Q000175:diagnosis / Q000209:etiology*; D054079:Vascular Malformations / Q000150:complications* / Q000175:diagnosis