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Arterial Anomalies of the Upper Limb and Their Influence on Transradial Coronary Procedures
Naveen Garg1, Pramod Sagar, Aditya Kapoor
1Department of Cardiology, Sanjay Gandhi PGIMS, Raibareli Road, Lucknow, India. navgarg@gmail.com and navgarg@sgpgi.ac.in.
Insights
Upper limb arterial anomalies, found in 9.7% of patients, significantly increase difficulties and failures during transradial coronary procedures, necessitating individualized navigation strategies.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Anatomy
Background:
- Transradial access is a common approach for coronary procedures.
- Anatomical variations in upper limb arteries can complicate transradial navigation.
- Understanding the incidence and impact of these anomalies is crucial for procedural success.
Purpose of the Study:
- To determine the incidence of upper limb arterial anomalies in patients undergoing transradial coronary procedures.
- To evaluate the impact of these anomalies on transradial navigation and outcomes.
Main Methods:
- 1195 consecutive patients undergoing transradial coronary procedures were assessed.
- Antegrade upper-limb arterial angiography was performed post-procedure.
- Radial artery angiography was used if guidewire or catheter navigation failed.
- Patient characteristics, arterial anatomy, and procedural outcomes were analyzed.
Main Results:
- Upper limb arterial anomalies were identified in 9.7% of patients, with high radial artery origin being most common (8.1%).
- Patients with anomalies experienced significantly higher rates of transradial navigation difficulties (42.7% vs 2.0%) and failures (9.4% vs 0.9%).
- Radial artery loops were associated with the highest navigation difficulties (63.6%) and failure rates.
- Increased fluoroscopy time, radiation dose, and complications like hematoma and occlusion were observed in patients with anomalies.
Conclusions:
- Upper limb arterial anomalies present a significant challenge in transradial coronary procedures.
- The type and severity of anomaly influence the degree of procedural impact.
- An individualized approach to navigation is essential for patients with these anatomical variations.
Objectives:
During transradial coronary procedures, arterial anomalies of the upper limb can lead to transradial navigation difficulties. We aimed to evaluate the incidence and impact of these anomalies on transradial procedures.
Methods:
In consecutive patients undergoing transradial coronary procedures, antegrade upper-limb arterial angiography was done at the end of the procedure with the catheter tip in the subclavian artery. Radial artery angiography from the sheath was done only if the guidewire or catheter could not be navigated. Patient characteristics, upper-limb arterial anatomy, and transradial outcomes were assessed.
Results:
Among 1195 patients, upper-limb arterial anomalies were noted in 117 patients (9.7%). High origin of the radial artery was the most common anomaly (8.1%) followed by radial artery loop (0.9%). Transradial navigation difficulties and failures were significantly more frequent in patients with these anomalies vs those without anomalies (42.7% vs 2.0% [P<.001] and 9.4% vs 0.9%, [P<.001], respectively). There was a greater need for radial road mapping and navigation assistance techniques, including balloon/pigtail assisted tracking. Passage for radial artery loop was associated with maximum navigation difficulties and higher transradial failure rate (63.6%). Fluoroscopy time, radiation dose, and transradial complications, including forearm hematoma and radial artery occlusions, were also significantly higher in patients with upper-limb arterial anomalies.
Conclusion:
Different upper-limb arterial anomalies are associated with different degrees of impact on transradial outcomes; these patients require an individualized approach for transradial navigation.
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