title: Comparison of Right and Left Upper Limb Arterial Variants in Patients Undergoing Bilateral Transradial Procedures.
abstract: BACKGROUND
  Transradial approach (TRA), when compared with transfemoral, improves the safety of percutaneous coronary procedures. Arterial axis variants are known to hinder the performance of transradial approach percutaneous coronary procedures. Data on the occurrence of arterial axis variants in the right and left arm arterial axes of individual patients are lacking.
  
  
  RESULTS
  From a single-center prospective registry, we selected all patients in whom bilateral upper limb arterial anatomy was assessed based on the performance of left and right radial catheterization obtained during the same or during repeat coronary diagnostic or interventional procedure(s). The occurrence of upper right and left limb arterial axis variants was classified according to the previously described operative ABC classification. A total of 610 patients were identified. An ABC upper limb arterial axis variant was detected in 156 (25.6%) patients. Variants were right-sided only in 65 (11.0%), left-sided only in 40 (6.6%), and bilateral in 46 (7.5%) patients. Thus, arterial axis variants were significantly more common in the right side (P=0.02). Bilateral arterial variants were significantly associated with age, female sex, and valvulopathy. Both A (radial/brachial) and B (axillary/subclavian/innominate) variants exhibited concordance across the 2 sides (odds ratio, 7.2; 95% confidence interval, 4.1-12.7 and 8.0; 95% confidence interval, 2.1-30.9, respectively).
  
  
  CONCLUSIONS
  The occurrence of an anatomic variant potentially hindering transradial approach coronary diagnostic or interventional procedures is bilateral in <8% of cases and is more common in the right arm. Such information may guide, during the clinical practice, the access selection in the case of repeat procedures or need for additional accesses.
authors.affiliation: From the 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.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Marta Francesca
authors.initials: MF
authors.lastname: Brancati
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Saffioti
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Coluccia
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.affiliation: From the Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery / Q000601:surgery*; D012189:Retrospective Studies; D034941:Upper Extremity / Q000098:blood supply*
keywords: catheterization; coronary angiography; percutaneous coronary intervention