Arterial Anomalies of the Upper Limb and Their Influence on Transradial Coronary Procedures.

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.