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Arterial variations in the upper limb are frequently observed. In the present study, we observed bilateral arterial variations in the upper limbs of a 75-year-old male cadaver during a routine anatomical dissection. In the right upper limb we discovered superficial and deep brachial arteries and anterior and posterior interosseous arteries which or...
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... Although one can often advance through loops, a precise technique is needed to reduce the risk of RA spasm and pain, making subsequent catheter manipulation and advance impossible. Other variations in the origin and branching patterns of the arteries of the arm have also been associated with possible obstacles during coronary angiography [17][18][19] ]. In cases of tortuous RA, the procedure was successful in all patients. ...
The transradial approach has been preferred compared to conventional transfemoral approach and/or transbrachial approach. Failure of the transra-dial approach has been reported in 1-5% of cases. Anatomical variations of the radial artery, however, could pose significant challenges to the interventional cardiologist and are the second most frequent reason for a high failure rate. The aim of this study was to share the experience with transradial approach in our institution, to report on the different anatomical variations and to discuss their role in failed catheterizations. A total of 314 patients were assessed. Normal anatomy of the radial artery was reported in 290 (92.4%) of patients, while different anatomical variations were found in 24 (7.6%). They included high origin of the radial artery, double radial artery and radial artery loop. We also observed a tortuous RA in 43 cases. Interventional cardiologists should be familiar with such variations and should have a clear plan on how to overcome the obstacles they pose and thus to avoid serious complications.
... Stanchev et al. [5] found a case showing bilateral variation in branching pattern of axillary artery. On the right side they found two profunda brachii arteries arose from the axillary artery along with other usual branches of axillary artery. ...
... The same authors reported that cardiac catheterization may be impeded by the following aberrant variants of the radial artery: tortuosities of the artery, a radial artery loop, a radio-ulnar loop or a course behind the biceps brachii tendon [15]. Anatomical variations, although not pathological in nature, can cause diagnostic and therapeutic difficulties, which is why they should always be have in mind by both surgeons and internists [10][11][12]24]. ...
Over the last decade, the transradial approach has become the preferred method for heart catheterization during diagnostic and therapeutic procedures. Compared to the more traditional transfemoral approach, it has significant advantages, including easier hemostasis, lower vascular complications (such as bleeding, thrombosis, fistulas and pseudoaneurysm), reduced hospital stay and improved healthcare costs. Nevertheless , it still poses significant challenges, such as smaller diameter and limitations on catheter size, longer procedure times, longer learning curve and variability of the artery. Several studies, however, point out that transradial approach failures and procedure times depend on the experience of the operator and are no different than those for the transfemoral approach once operators become proficient enough.
... Although the TR approach has the advantage of reduced local complications, it is associated with specific technical challenges and has relatively high incidence of catheterization failure. TR catheterization has different limitations: longer learning curve, failure to puncture the artery, limitations on catheter size, radial artery spasm and radial anatomical variations and others (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). ...
T he increased interest in radial artery anatomy stems from its preferred use as approach in interventional cardiology (1). The radial approach is an excellent alternative to the standard femoral approach for cardiac catheterization (2). Campeau (3) performed the first transradial (TR) percutaneous diagnostic coronary angiography in 1989. Later, in 1993, Kiemeneij (4) reported the first TR percutaneous coronary intervention. Nowadays, diagnostic and treatment procedures which utilise the TR approach are extremely frequent due to the high incidence of coronary artery disease. Studies on experimental models have proven the connection between coronary artery disease, hypertension and impaired myocardial function owing to alterations in the normal anatomy and physiology of the myocardium (5-7). Compared to the transfemoral (TF) approach, the TR approach is easily accessible, has fewer vascular complications (haematoma, thrombosis, pseudoaneurysm and arteriovenous fistula), ensures earlier mobilization, improves patient satisfaction and reduces hospital stay and hospital costs (8). Moreover, the TR approach has high efficacy, with success rates over 90% and failure of the procedure varies between 1-5% of cases (9). The advantages of TR approach are due to the fact that the radial artery is located just beneath the skin and provides easy access for haemostasis. Furthermore, if the above complications occur, they are usually treated nonoperatively. Another advantage of TR approach is the double blood irrigation of the hand, which prevents hand ischemia after radial artery thrombosis or spasm. Although the TR approach has the advantage of reduced local complications, it is associated with specific technical challenges and has relatively high incidence of catheterization failure. TR catheterization has different limitations: longer learning curve, failure to puncture the artery, limitations on catheter size, radial artery spasm and radial anatomical variations and others (9-18). The arterial variations of the upper limb are not uncommon and some of them could have definite clinical significance, especially radial artery variations. These variations include high bifurcating origin of the radial artery (high takeoff radial artery), radial artery loop, tortuosity, hypoplasia and stenosis (19). Jelev and Surchev (20) divided radial artery variations into two types. The first one, termed ''high-arm'', included variations of the radial artery in its origin and/or course with a normal diameter and ''usual'' access site at the wrist. These variations do not impede the initial transradial catheter insertion. Jelev and Surchev (20) reported the following anatomical variations that could impede cardiac catheterization: tortuosities of the artery, a radial artery loop, a radio-ulnar loop or a course behind the biceps brachii tendon. The second type of variations, termed ''low-arm'' variations, includes variations of the radial artery with possible hypoplasia and/or presenting with an atypical wrist access. The radial artery variations in this group may result in impossible (in cases of aplasia) or extremely difficult (in cases of hypoplastic arterial segments) wrist access to the radial artery. In this group, the variations of the radial artery could have a single arterial stem or exist as two vessels. In the latter case, the radial artery divides into two large arteries or gives off a branch of significant size, which results in a radial artery at the wrist with a smaller diameter than the normal one (20). In conclusion, anatomical variations are the second most common factor impeding transradial cathetherizations. Precise knowledge of these variations is essential to interventional cardiologists when performing transradial coronary procedures during left heart catheterization.
The transradial approach is an excellent alternative to the standard femoral approach for cardiac cathe-terization with success rates in over 90% of cases and has been widely used. Variations of the radial artery, however, could impede the cardiac catheterization and pose significant challenges to the interven-tional cardiologist. Herein, we report a failure of transradial heart catheterization due to high-bifurcating hypoplastic radial artery.
