Transradial angiography procedure approach in with and without radial artery anomalies

Saeed Yazdankhah, Ahmadreza Assareh, Shahla Majeedi, Mehdi Easapour, Mohammad Nourizadeh, Farzaneh Ahmadi, Farzad Daeinejad

Cardiovascular Disease Research Center, Joundishapour University, Ahvaz, Iran.
Cardiovascular Disease Research Center, Joundishapour University, Ahvaz, Iran;.

DOI: 10.4236/health.2013.56145                

Abstract

Introduction: The transradial coronary angiography has several benefits such as the reducetion in access site complications especially in fully anticoagulated patients. The presence of arterial anomalies in upper limb arteries has an important role in procedural success. Methods: retrograde transarterial sheath injection was done in patients with transradial coronary angiography. Arterial anomalies in the upper limb evaluated. Cannulation time, the time of catheter passage to ascending aorta, and Angiographic time, were also meseared. Results: in 2011, 165 consecutive patients were studied, 116 (70.3%) male, age 56.7 ± 11.1 years. With 96.6% success rate in procedure, totally 59 anomolies were observed in 44 patients (26.7%). Radial artery by itself had ?25 anomalies (15.1%). The most frequent anomaly was abnormal origin of radial artery in 14 patients (8.5%) followed by tortuosities in 10 ulnar (6%). 9 brachial (5.4%), 7 radial (4/2%), 5 subclavian (3%) and 3 brachiocephalic arteries (1.8%). There also were 4 loops in ulnar artery (2.4%) and one in radial and brachinl arteries (each 0.6%). Other anomalies include 4 patients (2.4%), except cannulation time (p = 0.97), there were associations between anomalies and each of other times (p = 0.001) and contrast volume (p = 0.009). Anomalies didn’t have any effect on procedural success rate and just in one patient with sulclavian loop procedure changed to femoral approach (p = 0.19).

Keywords

Transradial Angiography; Radial Anomalies

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kiemeneij, F., Laarman, G.J., Odekerken, D., Slagboom, T. and van der Wieken, R. (1997) A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: The ACCESS study. Journal of the American College of Cardiology, 29, 1269-1275. doi:10.1016/S0735-1097(97)00064-8
[2]	Cooper, C.J., El-Shiekh, R.A., Cohen, D.J., et al. (1999) Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison. American Heart Journal, 138, 430-436. doi:10.1016/S0002-8703(99)70143-2
[3]	Dery, J.P., Simard, S. and Barbeau, G.R. (2001) Reduction of discomfort at sheath removal during transradial coronary procedures with the use of a hydrophilic-coated sheath. Catheterization and Cardiovascular Interventions, 54, 289-294. doi:10.1002/ccd.1286
[4]	Louvard, Y., Lefevre, T. and Morice, M.C. (1997) Radial approach: What about the learning curve? Catheterization and Cardiovascular Diagnosis, 42, 467-468. doi:10.1002/(SICI)1097-0304(199712)42:4<467::AID-CCD30>3.0.CO;2-E
[5]	Louvard, Y., Pezzano, M., Scheers, L., Koukoui, F., Marien, C., Benaim, R., et al. (1998) Coronary angiography by a radial artery approach: Feasibility, learning curve. One operator’s experience. Archives des Maladies du Coeur et des Vaisseaux, 91, 209-215.
[6]	Goldberg, S.L., Renslo, R., Sinow, R. and French, W.J. (1998) Learning curve in the use of the radial artery as vascular access in the performance of percutaneous transluminal coronary angioplasty. Catheterization and Cardiovascular Diagnosis, 44, 147-52. doi:10.1002/(SICI)1097-0304(199806)44:2<147::AID-CCD5>3.0.CO;2-6
[7]	Louvard, Y. and Lefevre, T. (2000) Loops and transradial approach in coronary diagnosis and intervention. Catheterization and Cardiovascular Interventions, 51, 250-252. doi:10.1002/1522-726X(200010)51:2<250::AID-CCD24>3.0.CO;2-0
[8]	Kiemeneij, F., Laarman, G.J., Odekerken, D., Slagboom, T. and van der Wieken, R. (1997) A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: The access study. Journal of the American College of Cardiology, 29, 1269-1275. doi:10.1016/S0735-1097(97)00064-8
[9]	Ludman, P.F., Stephens, N.G., Harcombe, A., Lowe, M.D., Shapiro, L.M., Schofield, P.M., et al. (1997) Radial versus femoral approach for diagnostic coronary angiography in stable angina pectoris. American Journal of Cardiology, 79, 1239-1241. doi:10.1016/S0002-9149(97)00089-1
[10]	Barbeau, G.R. (2003) Radial loop and extreme vessel tortuosity in the transradial approach: Advantage of hydrophilic-coated guidewires and catheters. Catheterization and Cardiovascular Interventions, 59, 442-450. doi:10.1002/ccd.10586
[11]	Hildick-Smith, D.J., Ludman, P.F., Lowe, M.D., Stephens, N.G., Harcombe, A.A., Walsh, J.T., et al. (1998) Comparison of radial versus brachial approaches for diagnostic coronary angiography when the femoral approach is contraindicated. American Journal of Cardiology, 81, 770- 772. doi:10.1016/S0002-9149(97)01013-8doi:10.1007/BF02577379
[12]	Rodriguez-Niedenfuhr, M., Vazquez, T., Nearn, L., Ferreira, B., Parkin, I. and Sanudo, J.R. (2001) Variations of the arterial pattern in the upper limb revisited: A morphological and statistical study, with a review of the literature. Journal of Anatomy, 199, 547-566. doi:10.1046/j.1469-7580.2001.19950547.x
[13]	Rodriguez-Baeza, A., Nebot, J., Ferreira, B., Reina, F., Perez, J., Sanudo, J.R., et al. (1995) An anatomical study and ontogenetic explanation of 23 cases with variations in the main pattern of the human brachio-antebrachial arteries. Journal of Anatomy, 187, 473-479.
[14]	Yokoyama, N., Takeshita, S., Ochiai, M., Koyama, Y., Hoshino, S., Isshiki, T., et al. (2000) Anatomic variations of the radial artery in patients undergoing transradial coronary intervention. Catheterization and Cardiovascular Interventions, 49, 357-362. doi:10.1002/(SICI)1522-726X(200004)49:4<357::AID-CCD1>3.0.CO;2-Z
[15]	Uglietta, J.P. and Kadir, S. (1989) Arteriographic study of variant arterial anatomy of the upper extremities. CardioVascular and Interventional Radiology, 12, 145-148.
[16]	Yoo, B.S., Yoon, J., Ko, J.Y., Kim, J.Y., Lee, S.H., Hwang, S.O., et al. (2005) Anatomical consideration of the radial artery for transradial coronary procedures: Arterial diameter, branching anomaly and vessel tortuosity. International Journal of Cardiology, 101, 421-427. doi:10.1016/j.ijcard.2004.03.061
[17]	Valsecchi, O., Vassileva, A., Musumeci, G., Rossini, R., Tespili, M., Guagliumi, G., et al. (2006) Failure of transradial approach during coronary interventions: Anatomic considerations. Catheterization and Cardiovascular Interventions, 67, 870-878. doi:10.1002/ccd.20732
[18]	Rodriguez-Niedenfuhr, M., Sanudo, J.R., Vazquez, T., Nearn, L., Logan, B. and Parkin, I. (2000) Anastomosis at the level of the elbow joint connecting the deep, or normal, brachial artery with major arterial variations of the upper limb. Journal of Anatomy, 196, 115-119. doi:10.1017/S0021878299005737