title: Strategies to overcome hostile subclavian anatomy during transradial coronary angiography and interventions: impact on fluoroscopy, procedural time, complications, and radial patency.
abstract: BACKGROUND
  Hostile anatomy of the subclavian artery (severe tortuosity and/or heavy calcification) remains a significant obstacle for the transradial approach during coronary angiography and interventions.
  
  
  OBJECTIVE
  To assess impacts on fluoroscopy and procedural times, complications, and radial artery patency in patients with hostile subclavian anatomy by using multiple catheter-guide techniques.
  
  
  METHODS
  We retrospectively reviewed the medical and equipment data of 4,580 consecutive patients (mean age 74.4 ± 26.7 years, 49.5% females) who have been referred for transradial coronary angiography and/or interventions within the last 3 years (September 2010-September 2013). In order to overcome the strangling hold of a hostile subclavian artery, 2 techniques have been used: (1) for a coronary angiography-only procedure, a double mother and child technique; (2) for percutaneous coronary intervention, a triple mother and child technique.
  
  
  RESULTS
  Ninety-five patients (2.1%) from the entire study population exhibited a hostile subclavian artery. Fifty-two patients (1.1%) underwent coronary angiography only and 43 patients (1%) underwent interventions requiring the use of the above double or triple mother and child techniques, respectively. The 2 techniques were successful in 94.7% of patients (90/95 patients). The procedural time was significantly longer in the patients with hostile subclavian artery while there were no differences in the fluoroscopy time. The radial artery was patent at 30 days in 92.6% of patients (88/95 patients).
  
  
  CONCLUSIONS
  Our data showed that in the presence of hostile subclavian anatomy, the mother and child techniques appeared safe and effective, allowing for the completion of the intended procedure.
authors.affiliation: Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Legnago, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Dell'avvocata
authors.forename: Dobrin
authors.initials: D
authors.lastname: Vassiliev
authors.forename: Ramesh
authors.initials: R
authors.lastname: Daggubati
authors.forename: Aravinda
authors.initials: A
authors.lastname: Nanjiundappa
authors.forename: Massimo
authors.initials: M
authors.lastname: Giordan
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Azza
authors.forename: Paolo
authors.initials: P
authors.lastname: Cardaioli
authors.forename: Thach
authors.initials: T
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000503:physiopathology*; D006328:Cardiac Catheterization; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000502:physiology; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000503:physiopathology*; D013997:Time Factors; D014102:Torsion Abnormality / Q000503:physiopathology*; D014654:Vascular Patency / Q000502:physiology