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Are Radial Artery Anomalies a Major Cause of Transradial Procedure Failure?

Are Radial Artery Anomalies a Major Cause of Transradial Procedure Failure?. Ted S N Lo 1 , E Fountzopoulos 1 , R Butler 1 , S L Hetherington 2 , A Zaman 2 , James Nolan 1 , David Hildick-Smith 3 1. University Hospital of North Staffordshire, Stoke-on-Trent UK

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Are Radial Artery Anomalies a Major Cause of Transradial Procedure Failure?

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  1. Are Radial Artery Anomalies a Major Cause of Transradial Procedure Failure? Ted S N Lo1, E Fountzopoulos1, R Butler1, S L Hetherington2, A Zaman2, James Nolan1, David Hildick-Smith3 1. University Hospital of North Staffordshire, Stoke-on-Trent UK 2. Freeman Hospital, Newcastle-upon-Tyne, UK 3. Brighton and Sussex University Hospital, Brighton, UK

  2. Background 1 • The radial artery (RA) is increasingly used as a preferred access route for percutaneous coronary procedures. • It has minimal vascular complications, immediate ambulation and better post procedure comfort but is associated with a significant learning curve than femoral procedures.

  3. Background 2 Anecdotal evidence suggests that once the learning curve is passed, most transradial procedure failures are due to anatomical anomalies but there are currently limited data on such information. This study aims to systematically establish the incidence and significance of RA anomalies in patients undergoing transradial coronary procedures.

  4. Methods 1 • A multicentre prospective study – University Hospital of North Staffordshire, Brighton & Sussex University Hospital and Freeman Hospital. • From December 2005 to March 2007. • Retrograde radial arteriography using a short introducing sheath was performed in all patients presenting for a first-time radial procedure.

  5. Methods 2 Patient characteristics, procedural data, radial artery anatomy and local vascular complications were analysed. Procedure success is defined as completion of the intended procedure via the radial access route. Procedural duration is defined as time elapsed from patient entering the lab to leaving the lab.

  6. Methods 3 • Minor vascular complications are defined as: haematoma <5cm, vessel dissection & localised infection. • Major vascular complications are defined as: haematoma >5cm, pseudoaneurysm, any access site complications that required surgical or radiological intervention, >3gm Hb drop due to access site bleeding, bleeding requiring transfusion, limb ischaemia and compartment syndrome.

  7. Results 1: Patients and procedural characteristics Data in number, mean±SD and percentage. *hypertension, diabetes, peripheral vascular disease, previous CABG.

  8. Results 2: RA anatomy and procedural outcome

  9. Results 3: Breakdown of anatomy and procedural outcome *Percentage of failure to RA anatomical findings

  10. Normal Anatomy BA BA RA RA UA UA Interosseous & Median artery Interosseous artery

  11. High Bifurcating RA High bifurcating RA BA High bifurcating RA

  12. RA Loop & Recurrent RA 2 Remnant recurrent RA Large recurrent RA Complex large RA loop Small RA loop

  13. Tortuous RA Tortuous RA UA UA Tortuous RA

  14. Conclusions 1 • Anomalous RA anatomy is common and is the major cause of transradial procedural failures. • The commonest variation is high bifurcating radial origin which is normally of smaller calibre necessitating the use of 5F equipment.

  15. Conclusions 2 • Retrograde radial arteriography before the intended radial procedure helps to delineate the anatomy and identify patients with potentially unfavourable RA anatomy, and procedural technique can then be modified to facilitate successful catheterisation. • It should be incorporated into routine practice for transradial procedures.

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