Coronary catheterization via distal transradial access in patient with superficial radial artery: a case report.

BACKGROUND: The routine radial artery (RA) puncture may fail when anatomical variation of the RA is encountered. Superficial radial artery (SRA) is one of the anatomic variants of the RA, with the incidence of about 1 to 1.5%. Recently, distal transradial access (dTRA) has emerged as a novel approach for coronary catheterization (CC), but performing CC through dTRA in patient with SRA has never been reported. CASE PRESENTATION: A 57-year-old male was admitted to hospital due to intermittent chest pain for 4 days. He was diagnosed with unstable angina pectoris and planned to receive coronary angiography (CAG). Before the operation, the existence and course of SRA were confirmed by palpation and ultrasonography with color Doppler. We marked the puncture site under the guidance of ultrasonography and successfully performed CC through the dTRA during patient's hospitalization. CONCLUSIONS: As far as we know, this is the first report that presents a case of SRA and percutaneous coronary intervention (PCI) treatment in which was successfully performed through dTRA. It is safe and feasible to perform CC via dTRA in case of SRA, and dTRA seems to be the preferred access.

Different dose of heparin in preventing radial artery occlusion after transradial coronary angiography: A protocol for systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: When atherosclerosis occurs in the coronary artery, resulting in stenosis, occlusion, or spasm of the coronary artery, the supply of blood and oxygen to the myocardium will be reduced or even unavailable, resulting in myocardial necrosis and heart pain, chest tightness, dyspnea and other symptoms caused by myocardial necrosis are collectively referred to as coronary atherosclerotic heart disease. Coronary angiography can not only understand the degree of coronary artery damage, but also estimate the prognosis of coronary artery stenting, which provides a reliable reference for clinical treatment. Transradial coronary angiography (TCA) has the advantages of high success rate, small trauma, less complications, no bed rest, reduce hospital stay and other superiority, which accepted and used by physicians. Although the success rate of surgery is high, the postoperative complications will still affect the effect of surgery and the prognosis of patients. The main manifestations are radial artery occlusion (RAO), forearm hematoma formation, pseudoaneurysm formation, periosteal compartment syndrome, radial artery perforation, etc. Among the many ways to prevent RAO, anticoagulant therapy with common heparin is one of them, but the dosage of heparin is not clear. Therefore, we decided to use systematic evaluation to evaluate the clinical effectiveness and safety of different dose of heparin in preventing of RAO, and to provide clinical basis for the early prevention and treatment of RAO. METHODS: Two reviewers independently searched PubMed, Embase, the Cochrance Library, Web of Science, Medline, CBM Disc, CNKI, and WANFANG Data to find the eligible research. The retrieval about the randomized controlled trials of different dose of heparin in preventing the occurrence of RAO after TCA in recent years. The retrieval time is set between January 1990 and June 2020. The retrieval language is Chinese/English. Two researchers independently searched, managed and screened the literature through the search terms. When the 2 parties have inconsistent opinions on the inclusion or not of certain literature, the literature will be referred to the third researcher for discussion and decision. The included studies are conducted bias risk assessment through bias risk assessment tool, which based on Cochrane Handbook 5.0. The extracted data uses RevMan5.3 software for statistical processing. RESULTS: The research results of this systematic review will be published in peer-reviewed medical-related academic journals. CONCLUSION: This study adopts the Meta-analysis method and expands the sample size, which will give high-quality evidence-based medicine evidence on the clinical effectiveness and safety of different dose of heparin in preventing the occurrence of RAO. TRIAL REGISTRATION NUMBER: OSF, DOI 10.17605/OSF.IO/CPXJ3.

Navigating a proximal loop in the radial artery and avoiding the recurrent radial artery.

Several anatomical variations of the radial artery have been described in the literature. Common variations include radial artery loop, recurrent branch, and anastomotic channels connecting the radial and brachial arteries. These variations can pose significant technical challenges to safe radial artery catheterization. Because radial access for neurointervention is becoming popular, appreciation of these variations and mastery of techniques for safe radial artery catheterization are of paramount importance. In this operative video,(video 1) we present a case of a 75-year-old man who underwent middle meningeal artery embolization for treatment of chronic subdural hematoma using a transradial approach. The patient was found to have a radial artery loop and a recurrent branch off the radial artery. The loop could not be negotiated with the conventional technique. We therefore used a microcatheter system with a stiff microwire to navigate and straighten the radial loop under road map guidance. The remaining procedure was performed successfully.

Hypoplastic superficial brachioradial artery coexisting with atypical formation of the median and musculocutaneous nerves: a rare combination of unusual topographical relationships.

The use of the term "brachioradial artery" was introduced for the high origin of the radial artery. Although the prevalence of the brachioradial artery reported by different authors varies from 4.67 to 15.6%, the presence of the hypoplastic brachial segment of the brachioradial artery is rare with an occurrence rate of 0.83%. Moreover, in just 0.6% of cases the loop of the median nerve may be placed near half of the length of the brachial artery, as in the case described in our report. A comprehensive understanding of anatomical variations of neurovascular structures in the upper limb is of great clinical significance. The presented case report illustrates a rare manifestation of persistent primitive developmental relationships in the arterial pattern of the upper limb (persistent, hypoplastic brachial segment of the superficial brachioradial artery), coexisting with atypical formation of the median and musculocutaneous nerves. Anatomical variations of vessels and nerves may coexist which should be taken into account when performing vascular, reconstructive or orthopedic surgery.

Prevalence of Perforated Graft in Underlay and Pop-in Technique Myringoplasty.

INTRODUCTION: The radial artery is commonly originated from the brachial artery in the cubital fossa at the level of the neck of the radius. It is the artery of choice for coronary artery angiography, percutaneous coronary artery intervention, cannulation, and others. Radial artery anomalies like high origin, tortuosity, and accessory branches are associated with the failure of such procedures. The main objective of this study is to study the variation in origin and course of the radial artery in cadavers. METHODS: A descriptive cross-sectional study was conducted in 27 formalin-fixed adult human cadavers in the Department of Anatomy, KIST Medical College and Teaching Hospital, Lalitpur, Nepal, from 2075/4/2 to 2076/4/2. Ethical approval was taken on date 02/04/2075 (IRC No. 2074/75/38). Altogether, 53 specimens were enrolled in the study by convenience sampling method. Point estimate at 95% Confidence Interval was done for binary data along with frequency and proportion. The data was analyzed by and Statistical Package for the Social Sciences version 20. RESULTS: Out of of 53 upper limbs, forty-six (86.79%) specimens, the origin of the radial artery was observed to be normal in the cubital fossa, 34.5±6.31mm below the level of the intercondylar line of the humerus with the superficial course. In seven (13.21%) specimens, the radial artery showed variation in the origin. Among them, variations in origin were found to be from sites like the axilla, upper-middle, and lower part of the arm. One cadaver showed a tortuous radial artery bilaterally. CONCLUSIONS: This study concludes that most of the radial artery originates in the cubital fossa from the brachial artery with few variations.

[Aberrant birth of a radial artery in the upper third of the forearm: A case report]. / Naissance aberrante d'une artère radiale au tiers supérieur de l'avant-bras : à propos d'un cas.

We report the case of a 68-year-old patient, operated on in our department of a quadruple coronary bypass grafting. The grafting strategy consisted initially on harvesting the left internal thoracic artery and the left radial artery. The harvest of this latter failed because of a rare anatomical variation of the radial artery, which rose from the confluence of two branches: a superficial and a deep radial artery at the proximal third of the forearm approximately 10cm below the elbow.

Anatomical Variation of the Radial Artery Associated With Clinically Significant Ischemia.

PURPOSE: The purpose of this retrospective review was to investigate the incidence of radial artery anatomical variations in patients with clinically significant distal upper extremity (UE) ischemia. Available anatomical studies report that high takeoff of the radial artery occurs in up to 15% of the population. We hypothesized that there is a higher incidence of high origin of the radial artery in patients with clinically significant ischemia compared with the reported frequency in the general population. METHODS: We performed a retrospective review of all patients who underwent UE angiography for clinically significant hand and digital ischemia in our institution from 2012 to 2016. Data collected included patient age, sex, comorbidities, and modality of treatment. RESULTS: Twenty-six angiograms were performed for UE ischemia meeting inclusion criteria. Eight patients had Raynaud disease or scleroderma. Ten patients (38%) had high radial artery takeoff with radial artery origin proximal to the antecubital fossa. The need for surgical intervention was similar in patients with normal anatomy and those with high takeoff of the radial artery. CONCLUSIONS: Incidence of high radial artery takeoff was found more frequently in patients with distal UE ischemia requiring angiogram than in reported population data. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.

Anomalous Radial Artery as an Incidental Finding During a Routine Carpal Tunnel Release.

BACKGROUND: Compression of the median nerve at the wrist, or carpal tunnel syndrome, is the most commonly recognized nerve entrapment syndrome. Carpal tunnel syndrome is usually caused by compression of the median nerve due to synovial swelling, tumor, or anomalous anatomical structure within the carpal tunnel. METHODS: During a routine carpal tunnel decompression, a large vessel was identified within the carpal tunnel. RESULTS: The large vessel was the radial artery. It ran along the radial aspect of the carpal tunnel just adjacent to the median nerve. CONCLUSIONS: The unusual presence of the radial artery within the carpal tunnel could be a contributing factor to the development of carpal tunnel syndrome. In this case, after surgical carpal tunnel release, all symptoms of carpal tunnel syndrome resolved.

Origen alto de la arteria radial (Arteria braquirradial superficial): Presentación de 3 casos / High origin of the radial artery (superficial brachialarterial artery): Presentation of 3 cases

Se presentan tres casos de nacimiento alto de la arteria radial, todos en el miembro derecho, uno a nivel del tercio superior de la arteria braquial, el segundo caso a nivel del tercio medio de la misma y en el tercer caso el nacimiento de la arteria radial se produce a nivel de la arteria axilar. En todos los casos tienen un trayecto superficial en el brazo y antebrazo. En la mano forman el arco palmar arterial profundo de manera habitual. Estos casos representan el 7,5% de los 40 miembros disecados. El origen alto de la arteria radial es la variante más frecuente dentro de las anomalías del árbol arterial del miembro superior. Su importancia radica en el aumento de los procedimientos percutáneos sobre la arteria radial en cateterismos coronarios y en el cada vez más utilizado colgajo radial en las cirugías reconstructivas. Su trayecto superficial favorece los traumatismos y la confusión con venas, situación que puede ocasionar inyecciones medicamentosas accidentales en estas arterias con sus graves consecuencias.

We present three cases of high birth of the radial artery, all on the right limbone at the upper third of the brachial artery, the second at the middle third of the artery, and in the third case the radial artery arises at the level of the axillary artery. In all cases they have a superficial path in the arm and forearm. In the hand they form the deep arterial arch of the palmar in the usual way. These cases represent 7.5% of the 40 dissected members. The high birth of the radial artery is the most frequent variant within the arterial tree anomalies of the upper limb. Its importance lies in the increase of the percutaneous procedures on the radial artery in coronary catheterisms and in the increasingly used radial flap in the reconstructive surgeries. Its superficial pathway favors trauma and confusion with veins, a situation that can cause accidental drug injections in these arteries with their serious consequences.

Anomalies of radial and ulnar arteries / Anomalias nas artérias radial e ulnar

Abstract During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

Resumo Durante dissecção de membro superior direito de um cadáver de 70 anos, do sexo masculino, conduzida em um departamento de anatomia, foram observadas anomalias tanto na origem quanto no curso das artérias radial e ulnar. Após descer 5,5 cm desde a borda inferior do músculo redondo maior, a artéria braquial anomalamente se bifurcava em uma artéria radial medialmente, e em uma artéria ulnar lateralmente. No braço, a artéria ulnar se encontrava ao lado do nervo mediano, e seguia um curso normal no antebraço. A artéria radial se encontrava medialmente ao nervo mediano no braço e, então, no nível do epicôndilo medial, ela cruzava do lado medial para o lado lateral do antebraço, na superfície dos músculos flexores. O curso da artéria radial era superficial e tortuoso em todo o braço e antebraço. As variações das artérias radial e ulnar aqui descritas foram associadas a formação e curso anômalos do nervo mediano no braço. Conhecimento sobre anomalias neurovasculares são importantes para cirurgiões vasculares e radiologistas.

Congenital Bilateral Absence of the Radial Artery: A Very Rare Variation in Humans - Phylogenetic and Ontogenetic Aspects.

In an 80-year-old Caucasian woman, both radial arteries were found to be replaced by an enlarged anterior interosseous artery. Additionally, the right forearm revealed a persistent median artery which formed the superficial palmar arch together with the ulnar artery. In both hands, the replaced radial artery was connected only to the deep but not the superficial palmar arch. In clinical practice, lack of an arterial pulse on the radial aspect of the wrist joint may indicate the presence of this anatomic variation. In this case, arterial blood sample collections, application of contrast media, invasive measurements of blood pressure, and several angiographic interventions cannot be performed via the radial artery. As this is the fourth reported case since 1830, bilateral aplasia of the radial artery appears to be an exceptional variation in humans. Thus, the phylo- and ontogenetic aspects of this anomaly are discussed.

Low origin of the radial artery: a case study including a review of literature and proposal of an embryological explanation.

A low origin of the radial artery is a rare anatomical variation, with the incidence estimated at 0.2 %. This report presents a previously unrecorded case of an unusual distal origin of the radial artery, co-occurring with a double recurrent radial artery. The radial artery arose under the pronator teres muscle, 76 mm below the intercondylar line of the humerus. After emerging from under the tendon of the pronator teres muscle, the radial artery took a typical course and terminated in the deep palmar arch. Additionally, the double radial recurrent artery branched directly off the brachial artery, near the level of the radial neck. A well-developed muscular branch of the first radial recurrent artery ran beneath the brachioradialis muscle and supplied the brachioradialis, extensor carpi radialis longus and brevis, as well as supinator muscles. The second (accessory) radial recurrent artery took origin from the posterior aspect of the brachial artery, ran deep to the distal tendon of the biceps brachii muscle and terminated by joining the articular network of elbow. According to recent theories, the plexiform appearance of the arteries at early stages of upper limb development allows for formation of alternative pathways of blood flow, which may give rise to variations in the definitive arterial pattern.

Anomalous Medial Branch of Radial Artery: A Rare Variant.

Radial artery is an important consistent vessel of the upper limb. It is a useful vascular access site for coronary procedures and its reliable anatomy has resulted in an elevation of radial forearm flaps for reconstructive surgeries of head and neck. Technical failures, in both the procedures, are mainly due to anatomical variations, such as radial loops, ectopic radial arteries or tortuosity in the vessel. We present a rare and a unique anomalous medial branch of the radial artery spiraling around the flexor carpi radialis muscle in the forearm with a high rising superficial palmar branch of radial artery. Developmentally it probably is a remanent of the normal pattern of capillary vessel maintenance and regression. Such a case is of importance for reconstructive surgeons and coronary interventionists, especially in view of its unique medial and deep course.