Analysis of Factors Affecting the Technical Difficulties to Pass the Aortic Arch in Left Transradial Access for...

To determine how the anatomical morphology of the left subclavian artery and aortic arch affects the technical difficulty of navigating the aortic arch during left transradial access for visceral vascular interventions.

We retrospectively evaluated 98 patients who underwent visceral vascular interventions using left transradial access from January 2022 to December 2022. Cannulation of the descending aorta was considered difficult when the time required to manipulate the catheter in the aortic arch exceeded 30 seconds. The morphologies of the left subclavian artery and aortic arch were evaluated by measuring [1] the angle between the left subclavian artery to the apex of the aortic arch, [2] the angle of incidence of the left subclavian artery in the horizontal direction, and [3] the distance from the left edge of the left subclavian artery origin to the apex of the aortic arch using computed tomography images. The values of [1], [2], and [3] were evaluated using the Mann-Whitney U test.

The median and mean catheterization times were 26 seconds (range, 2-1,312) and 112.4 ± 226.0 seconds, respectively. For difficult (n = 44) and not-difficult (n = 54) cases, the mean values of [1], [2], and [3] were 111.8° vs. 140.8° (p < 0.001), 67.3° vs. 76.9° (p < 0.001), and 27.5 mm vs. 24.7 mm (p = 0.001), respectively.

Technical difficulty in passing the aortic arch during left transradial access is more likely in patients with steep angles of the left subclavian artery or steep angles between the left subclavian artery and the apex of the aortic arch.