title: Working through complexities of radial and brachial vasculature during transradial approach.
abstract: OBJECTIVE
  The aim of this review is to discuss different methods of working through radial artery (RA) and brachial artery (BA) vascular complexities to increase the success rate of transradial approach (TRA).
  
  
  BACKGROUND
  Anatomical complexities of RA and BA vasculature are an important reason for failure of TRA. There are few current data describing methods to overcome these challenges and reduce TRA failure.
  
  
  METHODS
  A series of the primary RA and BA anatomical complexities are identified and management techniques to overcome these variants are discussed.
  
  
  RESULTS
  RA and BA vascular complexities can be divided into three subsets including (1) radial artery spasm (RAS); (2) variant anatomy including tortuosity, loops, and anomalous origin of RA; (3) acquired abnormalities including perforations, atherosclerotic lesions, and calcification of RA. In-depth discussion with supportive examples for the identification and management of these challenges are provided. A classification of RAS and perforations is shown and simple algorithms that have been developed for management of RAS, perforations and loops are explained.
  
  
  CONCLUSIONS
  Despite lower rates of bleeding and vascular complications as compared to transfemoral approach (TFA), the adoption has been relatively slow particularly due to higher failure rates. Anatomical complexities of RA and BA vasculature play an important role for TRA failure cases. Using a simply framework to classify the anatomical or functional problem, and then approach these challenges in a logical sequence should facilitate management and increase success rate for TRA.
authors.affiliation: Apex Heart Institute, Ahmedabad, India; Department of Cardiology, Sheth V.S. General Hospital and Smt. N.H.L. Municipal Medical College, Ahmedabad, India.
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shah
authors.forename: Samir
authors.initials: S
authors.lastname: Pancholy
authors.forename: Rajnikant
authors.initials: R
authors.lastname: Radadiya
authors.forename: Surender
authors.initials: S
authors.lastname: Deora
authors.forename: Chirayu
authors.initials: C
authors.lastname: Vyas
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon
authors.forename: Ian C
authors.initials: IC
authors.lastname: Gilchrist
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001916:Brachial Artery; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D017534:Radial Artery
keywords: complication; percutaneous coronary intervention; perforation; radial artery loop; radial artery spasm; transradial approach