Abstract 15311: Anomaly and Narrowing of Radial Artery and its Impact to the Transradial Angiography and Intervention

Abstract

[Background] Increasing number of transradial coronary procedures are now performed because of the advantage of reduced access site complications. However, transradial approach sometimes ends in failure or vascular complication due to arterial anomaly or stenosis. [Objective] The objective of this study was to clarify the types and frequency of radial or brachial arterial anomaly and narrowing in patients who undergone cardiac catheterization. [Methods] Total of 1135 consecutive patients who underwent transradial cardiac angiography or intervention from Jan. 2013 to May 2015 were subjected. In all cases, angiography of radial and brachial arteries was performed through the inserted sheath. After removing the duplicating cases, we analyzed 826 arms of 786 patients. [Results] Of total 826 angiographies, 622 were identified as normal. There were 20 (2.4%) cases of 'high-bifurcation' in which radial artery originates proximal of the intercondylar line of the humerus. 'Radial loop' with a full 360 degree loop of the radial artery and accompanied by the recurrent artery which originates at the loop was identified in 9 (1.1%) cases. 'Radial simple loop' and 'brachial simple loop' with a full 360 degree loop without recurrent artery were observed in 5 (0.6%) and 6 (0.7%) cases, respectively. 'Radial or brachial tortuosity' with a bend of more than 90 degree existed in 64 (7.7%) and 45 (5.4%) cases, and 'narrow radial or brachial' with the vessel diameter <2.0mm in 113 (13.7%) and 5 (0.6%) cases (some cases were duplicated). In high bifurcation, loop, or tortuosity cases, narrowing of the vessels of catheter route also coexisted in 20-89% cases. Cardiac catheterization ended in failure in 7 (1.1%) of normal radial and brachial artery cases, and in 31 (11.6%) cases of radial or brachial arterial abnormalities (p<0.0001). Among the 31 failure cases with radial or brachial artery abnormalities, the cause of the failure was narrowing of a catheter route in 24 (77%) cases, and 1 case with both radial tortuosity and narrowing ended in radial artery perforation. [Conclusion] Radial artery anomaly and narrowing are not infrequent and often coexist, and lead to procedure failure or even vascular complications, indicating a need of confirmation of vascular anatomy by angiography.