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Angiographic evaluation of right upper-limb arterial anomalies: implications for transradial coronary interventions
Toshiharu Fujii1, Naoki Masuda, Seiji Tamiya
1Division of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
Insights
Right upper-limb arterial anomalies occur in 23.3% of patients undergoing coronary angiography. Most anomalies do not preclude transradial procedures, with only radio-ulnar loops posing a significant concern.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Anatomy
Background:
- Transradial coronary procedures are limited by upper-limb arterial anomalies.
- These anomalies can lead to procedural failure and vascular complications.
- Many operators avoid transradial approaches due to these concerns.
Purpose of the Study:
- To determine the frequency of right upper-limb arterial anomalies.
- To assess the anatomical variations of these anomalies.
- To evaluate the impact of these anomalies on transradial coronary procedures.
Main Methods:
- Prospective study of 163 consecutive patients undergoing transbrachial coronary angiography/intervention.
- Antegrade transbrachial arteriography of right upper-limb arteries was performed post-procedure.
- Frequency and anatomy of arterial anomalies were investigated.
Main Results:
- 40 upper-limb arterial anomalies were found in 38 patients (23.3%).
- Common anomalies included abnormal origins (4.9%), radio-ulnar loops (1.2%), and tortuosities (15.3%).
- Congenital anomalies were mainly abnormal radial artery origins; acquired anomalies were predominantly tortuosities.
Conclusions:
- Despite a 23.3% incidence of right upper-limb arterial abnormalities, most patients remain suitable for transradial coronary intervention.
- Only 1.2% of patients with radio-ulnar loops were deemed unsuitable.
- Transradial procedures can be considered even with a high prevalence of arterial variations.
Objectives:
Upper-limb arterial anomalies are sometimes encountered during transradial coronary procedures. These anomalies may contribute to procedural failure or to vascular complications, and are a major reason why many operators tend to avoid transradial procedures. We investigated the frequency of right upperlimb arterial anomalies using antegrade arteriography in patients undergoing transbrachial coronary angiography or intervention, and discuss the potential impact of these anomalies on the transradial procedure.
Methods:
We prospectively studied 163 consecutive patients who underwent right transbrachial coronary angiography or intervention for the first time during the period from May 2007 to December 2007. Following the transbrachial procedure, we performed antegrade transbrachial arteriography of right upper-limb arteries in these patients and investigated the frequency and anatomy of arterial anomalies.
Results:
A total of 40 upper-limb arterial anomalies were observed in 38 patients (23.3%). These included 8 abnormal origins (4.9%), 2 radio-ulnar loops (1.2%), 25 tortuosities (15.3%), 4 stenoses (2.5%) and 1 loop (0.6%). In patients with congenital lesions (8 patients; 4.9%), abnormal origin of the radial artery was the most common anomaly encountered, and in the acquired group (25 patients; 15.3%), tortuosity was the most common abnormality.
Conclusion:
Even with a 23.3% incidence of right upper-limb arterial abnormalities, 98.8% of patients were acceptable for transradial coronary intervention except for 1.2% of radio-ulnar loops.
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