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.

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Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Cardiology ◽

10.1159/000488852 ◽

2018 ◽

Vol 140 (2) ◽

pp. 74-82 ◽

Cited By ~ 3

Author(s):

Matteo Tebaldi ◽

Simone Biscaglia ◽

Carlo Tumscitz ◽

Annamaria Del Franco ◽

Francesco Gallo ◽

...

Keyword(s):

Radial Artery ◽

Primary Outcome ◽

Study Groups ◽

Adjunctive Treatment ◽

Access Site ◽

Double Blind ◽

Access Site Complication ◽

Heparin Administration ◽

Coronary Procedures ◽

Sheath Insertion

Objective: We sought to demonstrate that the combination of a local vasodilator (verapamil), modern materials, patent hemostasis, and intravenous anticoagulant only in the case of percutaneous coronary intervention, as compared to default heparin administration after sheath insertion, may optimize a combined endpoint, including radial artery occlusion (RAO), radial artery spasm (RAS), and access site complication. Methods: This is a prospective, single-center, double-blind randomized trial. Overall, 418 patients undergoing a transradial approach (TRA) for coronary procedures were randomized 1: 1 to receive intraradial verapamil (5 mg) or heparin (5,000 IU) after a 6-Fr sheath insertion. The primary outcome was the 24-h occurrence of RAO (ultrasound confirmation), access site complication, and RAS requiring the bailout administration of vasodilators. Results: The combined primary outcome occurred in 127 (30%) patients. It was significantly lower in patients randomized to verapamil as compared to others (26 vs. 35%, p = 0.03). This was mainly due to a significant reduction in RAS (3 vs. 10%, p = 0.006). The 24-h and 30-day occurrence of RAO did not differ between the study groups. Conclusion: Local administration of verapamil versus heparin reduces RAS, without increasing RAO, which appears to be strictly related to radial artery diameter and hemostasis time.

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Outcome off Primary Coronary Angioplasty by Radial Route: Study on 100 Cases

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i06/06 ◽

2018 ◽

Vol 3 (06) ◽

Author(s):

Dr. Dilip Ratnani ◽

Dr. Rekha Ratnani

Keyword(s):

Hospital Stay ◽

Radial Artery ◽

Bleeding Complications ◽

Access Site ◽

Transfemoral Approach ◽

Artery Cannulation ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Radial Access ◽

Coronary Procedures

Recently radial artery is being used as a vascular access route for coronary procedures. Primary angioplasty with transfemoral procedure is associated with high access site bleeding complications due to use of potent antiplatelets and anticoagulants therefore radial access should be preferred if the operators are experienced and familiar with the technique. Methods: Total 100 pa‡…tients were included in the study in which procedure was performed by the trans radial route. All routine laboratory investigations were performed. Support of a temporary pacemaker was kept ready. All patients were prepared according to the Cardiac Catheterization Laboratory Standards. Radial artery cannulation was performed. Results: 100 patients were included in the study selected for radial route. Mean age of the patients who underwent primary CAI was 59±8.4. The most affected artery in the as shown angiography was Left anterior descending (58%) followed by Right coronary artery (41%). Least affected artery was left main (6%) and Ramus intermedius (6%). Mean of diseased vessels was 1.34 ± 1.25. Crossover from radial to femoral route was done on 5 patients of which 2 patients were having radial artery anomaly and in 3 patients arterial puncture was not successful. Mean hospital stay of the patients after procedure was 6.8 ± 2.1. Conclusion: transradial approach for coronary procedures is a safe technique and gives similar clinical results to transfemoral access. Complications at the radial access site are negligible. Length of hospital stay, time to mobilisation and cost all are reduced in the transfemoral approach.

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Radial artery pseudoaneurysms after transradial cardiac catheterisation

VASA ◽

10.1024/0301-1526/a000529 ◽

2016 ◽

Vol 45 (3) ◽

pp. 229-232 ◽

Cited By ~ 8

Author(s):

Jehangir N. Din ◽

Aengus Murphy ◽

Karen Chu ◽

Patty Forman ◽

Richard D. Mildenberger ◽

...

Keyword(s):

Clinical Features ◽

Radial Artery ◽

Femoral Artery ◽

Surgical Repair ◽

High Volume ◽

Cardiac Catheterisation ◽

Access Site ◽

Artery Pseudoaneurysm ◽

Diagnostic Angiography ◽

Coronary Procedures

Abstract. Background: Although uncommon, radial artery access site complications are likely to become more frequent with the increased adoption of transradial cardiac catheterisation. There is a lack of data regarding the incidence and clinical features of radial artery pseudoaneuryms. We aimed to describe the incidence, clinical features and management of radial artery pseudoaneurysms in a high-volume transradial cardiac catheterisation centre. Patients and methods: We performed a search of the Vancouver Island Health Authority medical imaging database from 1st Jan 2008 to April 2012 looking for all radial and femoral artery pseudoaneuryms occurring after cardiac catheterisation. Hospital charts were reviewed to determine patient and procedural characteristics as well as management and outcome. Results: There were a total of 14,968 coronary procedures performed over the four year search period, of which 13,216 (88 %) were trans-radial. The incidence of radial artery pseudoaneurysm after cardiac catheterisation was 0.08 %, and did not differ between transradial diagnostic angiography and PCI (0.07 % vs 0.08 %; P = 0.90). In contrast, the incidence of femoral artery pseudoaneurysm was higher, at 1.4 % (P < 0.0001). Patients with radial pseudoaneurysms were generally elderly, with a median age of 77 years, and there were no gender differences. Only one patient had received a glycoprotein IIb / IIIa inhibitor, whilst two received warfarin post-procedure. The majority of cases (80 %) were treated with surgical repair. Conclusions: We have demonstrated that radial artery pseudoaneuryms are a rare but important complication of transradial cardiac catheterisation, with patients generally requiring surgical repair. Most patients were elderly, but surprisingly only a minority were anti-coagulated with warfarin.

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Is radial artery occlusion and local vascular complications following transradial coronary procedures affected by the type of haemostasis device used? A non-inferiority Randomized Controlled Trial (RadCom trial)

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab004 ◽

2021 ◽

Author(s):

Nicole Due-Tønnessen ◽

Cecile H Egeland ◽

Oliver J Meyerdierks ◽

Anders Opdahl

Keyword(s):

Radial Artery ◽

Controlled Trial ◽

Vascular Complications ◽

Artery Occlusion ◽

Radial Compression ◽

Complication Rates ◽

Access Site ◽

Randomized Controlled ◽

Coronary Procedures ◽

Radial Artery Occlusion

Abstract Aims Vascular access site complications following transradial coronary procedures are less common and severe compared to femoral approach. Radial artery occlusion is considered the main adverse effect. As radial access is gaining more acknowledgement, complication awareness, and understanding is important. The aim was to assess complication rates following transradial coronary procedures and to compare two radial compression devices in a non-inferiority randomized controlled trial. Methods and results Four hundred and ninety-nine patients were randomized to radial compression with a new device (RY Stop, n = 248) or the reference device (TR Band, n = 251) following transradial coronary procedures. Radial artery occlusion persistent at 90 days was the primary endpoint. Discomfort and accounts of vascular complications at access site were secondary endpoints. Radial artery occlusion was observed in 5% (n = 26) for the entire cohort with no difference between groups (RY Stop 6% vs. TR Band 5%; P = 0.69). Patients overall reported low levels of discomfort and the median scores were similar in both groups; RY Stop: 7 vs. TR Band: 10 (P = 0.90). There were few incidents of bleeding (7%), however, they were significantly more frequent with the RY Stop (12%) than with the TR Band (3%; P = 0.001). Few patients (4%) developed access site haematomas, and the incidence was similar in the two groups (P = 0.98). Conclusion We observed a radial artery occlusion rate of 5% at 90 days post-procedure. Access site discomfort and vascular complication rates were low. Overall, the RY Stop compression device was not inferior to the TR Band except occurrences of bleeding.

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Prevalence of Accessory Branches and Other Anatomical Variations in the Radial Artery Encountered during Radial Forearm Flap Harvest: A Systematic Review and Meta-analysis

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1713600 ◽

2020 ◽

Vol 36 (09) ◽

pp. 651-659 ◽

Cited By ~ 1

Author(s):

Ryan D. Hoffman ◽

Denise M. Danos ◽

Samuel J. Lin ◽

Frank H. Lau ◽

Peter S. Kim

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Radial Artery ◽

Case Reports ◽

Meta Analysis ◽

Anatomical Variations ◽

Radial Forearm Flap ◽

Anatomical Variants ◽

Radial Forearm ◽

Allen Test

Abstract Background Harvest of the radial forearm flap (RFF) for reconstructive surgery is proceeded by the Allen test to assess for adequate contralateral perfusion of the hand, yet the Allen test may fail to detect anatomical variations in the radial artery such as aberrant branching. Therefore, the goal of this study was to systematically review the literature regarding anatomical abnormalities of the radial artery that can affect flap harvest and to perform a meta-analysis to estimate the prevalence of such abnormalities. Methods A systematic review of the literature was conducted using five online databases to identify all instances of radial artery anatomical variations. Abstracts were reviewed and categorized into either (1) large cohort studies of anatomical variations identified by angiogram or (2) case reports specifically mentioning anomalous or accessory branches of the radial artery. Data from the large cohort studies were included in a random effect meta-analysis to estimate the prevalence of such variations. Results Eighteen angiogram cohort studies containing a total of 18,115 patients were included in the meta-analysis. Accessory branches were the least common anatomical variant reported, with an estimated average prevalence of 0.5%. Prevalence estimates for more common anatomical variants, including radial artery loops (0.9%), stenosis (1.3%), hypoplasia (1.9%), tortuosity (4.3%), and abnormal origin (5.6%), were also calculated. Thirteen case reports detailing anomalous branches of the radial artery were identified, seven of which involved accessory branches encountered during RFF harvest with no incidence of flap loss. Conclusion Radial artery accessory branches are exceedingly rare, but the prevalence of other anatomical variations that can affect harvest of the RFF warrants consideration. We recommend surgeons consider comprehensive screening prior to RFF harvest to avoid intraoperative discovery of anatomical variants and suggest a low threshold for repeat perfusion testing intraoperatively if radial artery accessory branches are encountered.

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The radial artery: an alternative access site for diagnostic and interventional coronary procedures

Irish Journal of Medical Science (1971 -) ◽

10.1007/bf03169153 ◽

2005 ◽

Vol 174 (3) ◽

pp. 79-83 ◽

Cited By ~ 6

Author(s):

N. T. Mulvihill ◽

P. A. Crean

Keyword(s):

Radial Artery ◽

Access Site ◽

Coronary Procedures

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Access-site complications of the transradial approach: Rare but still there.

Current Cardiology Reviews ◽

10.2174/1573403x16999200819101923 ◽

2020 ◽

Vol 16 ◽

Author(s):

Stelina Alkagiet ◽

Dimitrios Petroglou ◽

Dimitrios N. Nikas ◽

Theofilos M. Kolettis

Keyword(s):

Radial Artery ◽

Artery Occlusion ◽

Tissue Loss ◽

Access Site ◽

Transradial Approach ◽

Financial Benefits ◽

Eversion Endarterectomy ◽

Life Threatening ◽

Sheath Insertion ◽

Venous Fistula

: In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA's anatomical advantages, in addition to patients' acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories. Access-site complications of TRA are rare, and usually of little clinical impact, thus they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach. On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA's complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

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