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The feasibility of bypass graft angiography by right radial access
Jae Hoon Lee1, Min-Ji Kim, Kwang Soo Cha
1Cardiology Division, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
Insights
Right radial access for coronary angiography is a viable option for bypass graft imaging in most patients. This approach helps preserve the left radial artery for potential future use as a graft, avoiding complications.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access
Background:
- Left transradial coronary angiography can damage both radial arteries after right radial access.
- The left radial artery is sometimes used as a graft in patients undergoing bypass surgery.
Purpose of the Study:
- To investigate the feasibility of graft angiography using right radial access.
- To determine if this method can preserve the left radial artery for future use.
Main Methods:
- 109 consecutive patients with bypass surgery underwent graft angiography via right radial access.
- Exclusion criteria included severely tortuous right subclavian artery.
- Success rates and graft visualization were analyzed for saphenous vein and left mammary artery grafts.
Main Results:
- 16% of patients were excluded due to tortuous subclavian arteries.
- Successful angiography was achieved in 97% of patients via right radial or brachial access.
- High rates of selective cannulation and satisfactory image quality were reported for both saphenous vein and left mammary artery grafts, with no procedure-related complications.
Conclusions:
- Right radial access is a reliable method for graft angiography in patients without severe subclavian artery tortuosity.
- This technique effectively visualizes bypass grafts while preserving the left radial artery.
Background And Objectives:
Left transradial coronary angiography may result in damage of both radial arteries in patients who experienced right radial access. In some patients, the left radial artery has been used as a graft. We investigated whether graft angiography using right radial access is feasible in patients with bypass surgery to preserve the left radial artery as a future graft.
Subjects And Methods:
A total of 109 consecutive patients with bypass surgery who had undergone right radial access underwent graft angiography via the same access.
Results:
Sixteen (15%) patients were excluded because of the presence of a severely tortuous right subclavian artery. Bypass graft angiography via right radial or brachial access was completed successfully in 90 (97%) out of 93 patients. In 3 (3%) of patients, femoral access was needed to complete the angiography. Saphenous vein grafts were cannulated selectively in 150 (90%) of 167 grafts with satisfactory image quality and not found even on the aortogram in the other 17 (10%) grafts. Ninety-two (89%) out of 103 left mammary grafts were cannulated selectively or semi-selectively using a modified Simmons catheter, resulting in satisfactory image quality. The other 11 (11%) grafts were visualized non-selectively using a Judkins Left catheter, and resulting in acceptable image quality in 10 (91%) grafts. There were no procedure-related complications.
Conclusion:
Graft angiography via right radial access can be performed reliably in most patients that lack severe subclavian tortuosity.
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