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Ford TJ, Bamford P, Barlis P, Said C. Radial Artery, Alternative Arm Access, and Related Techniques. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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2
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Wang P, Wang Q, Bai C, Zhou P. Iatrogenic aortic dissection following transradial coronary angiography in a patient with an aberrant right subclavian artery. J Int Med Res 2020; 48:300060520943789. [PMID: 32787591 PMCID: PMC7427028 DOI: 10.1177/0300060520943789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An aberrant right subclavian artery is a congenital aortic arch anomaly in which the right subclavian artery originates from the proximal descending aorta. The presence of an aberrant right subclavian artery can make right transradial coronary interventions more difficult and even lead to complications. Iatrogenic intramural hematomas and dissection of aberrant right subclavian arteries during transradial coronary angiography have been previously reported. We herein report a case of iatrogenic aortic dissection following attempts to perform right transradial coronary angiography in a patient with an aberrant right subclavian artery. Clinicians should be vigilant for the presence of an aberrant right subclavian artery during right transradial coronary angiography and ensure gentle manipulation of wires and catheters to avoid complications.
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Affiliation(s)
- Peijian Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
| | - Qiulin Wang
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
| | - Chen Bai
- Department of Imaging, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
| | - Peng Zhou
- Department of Cardiology, The First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan, China
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3
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Abstract
Dysphagia lusoria is rare embryologic defect of the aortic arch vasculature characterized by an aberrant retro-esophageal course of the right subclavian artery (RSA), comprising a vascular sling. This may manifest clinically with symptoms of dysphagia or reflux. Given the rarity of this pathology, there remains uncertainty regarding the most effective treatment algorithm. Vascular decompression procedure surgery is often used to rectify the aberrant vascular morphology. However, a low percentage of aberrant arteries result in trachea-esophageal symptoms. As such, we suggest (1) one must exclude co-morbid esophageal motility disorders in patients with dysphagia; and (2) aberrant RSA may be a cause of dysphagia, so-called dysphagia lusoria, but represents an unlikely mechanism, since this morphological arrangement typically does not result in a highly constrictive, circumferential vascular ring. It follows, therefore, that directly addressing the esophageal motility issue should take precedence over complex and potentially noncurative vascular procedures directed to the aberrant RSA. However, the presence of marked aneursymal dilation of the aberrant RSA, and/or the presence of a bicarotid (socalled bovine) trunk, would favor vascular repair in the clinical decision-making due to the elevated risk of rupture and more severe esophageal compression in these specific situations.
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Affiliation(s)
- Michael Coles
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - Amol Sharma
- Division of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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4
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Affiliation(s)
| | - Daniel R Obaid
- Swansea University Medical School and Morriston Cardiac Centre, Swansea, UK
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5
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Woody WW. Radial first, radial second, and beyond. Catheter Cardiovasc Interv 2019; 93:562. [PMID: 30196544 DOI: 10.1002/ccd.27818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/14/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Walter W Woody
- Interventional Cardiologist, Baptist Memorial Hospital North Mississippi, Oxford, Mississippi
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6
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Jahangeer S, Bashir M, Harky A, Yap J. Aberrant subclavian: new face of an old disease. J Vis Surg 2018; 4:108. [PMID: 29963397 DOI: 10.21037/jovs.2018.05.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/04/2018] [Indexed: 01/04/2023]
Abstract
An aneurysm of an aberrant subclavian artery is un usual prevalence of anomalies of aortic arch, with a literature reported prevalence of 2%. Timely elective intervention is of paramount. The advancement in stenting techniques has promoted this practice to be an alternative to conventional open surgical repair which is associated with high rates of perioperative complications including mortality outcomes. However, new faces of this old disease are emerging as we move to novelty and innovation era. We discuss in this review the advancements in this disease entity highlighting and collecting the world experiences.
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Affiliation(s)
- Saleem Jahangeer
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Mohamad Bashir
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Amer Harky
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.,School of Medicine, Cardiff University, Cardiff, UK
| | - John Yap
- Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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7
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Rafiq A, Chutani S, Krim NR. Incidental finding of arteria lusoria during transradial coronary catheterization: Significance in interventional cardiology. Catheter Cardiovasc Interv 2017; 91:1283-1286. [PMID: 29219241 DOI: 10.1002/ccd.27439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 11/12/2017] [Indexed: 01/23/2023]
Abstract
Arteria lusoria is the most common anomaly of the aortic arch with an incidence of 0.5%-2.5%. It is mostly diagnosed incidentally while performing imaging for evaluation of other unrelated medical conditions. The aberrant right subclavian artery arises beyond the origin of the left subclavian artery from the aortic arch. This results in a complex right-subclavian-aortic anatomy which leads to difficulty in transradial coronary angiography. This can lead to prolonged procedure time and increased use of catheters by unaware interventionists. This is even more important if this is encountered in the setting of an acute myocardial infarction. Our review takes into account clinical significance of this uncommon anomaly in the field of interventional cardiology.
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Affiliation(s)
- Arsalan Rafiq
- Department of Cardiology, Mount Sinai St. Luke's Hospital-Bronx Lebanon Hospital Center, Bronx, New York
| | - Surendra Chutani
- Department of Cardiology, Mount Sinai St. Luke's Hospital-Bronx Lebanon Hospital Center, Bronx, New York
| | - Nassim R Krim
- Department of Cardiology, Bronx Lebanon Hospital Center, Bronx, New York
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8
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Ford TJ, Ng MK, Thondapu V, Barlis P. Radial Artery, Alternative Arm Access, and Related Techniques. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Thomas J. Ford
- St. George Hospital; Sydney Australia
- University of New South Wales; Sydney Australia
| | - Martin K.C. Ng
- University of New South Wales Medical School, The University of Sydney; Australia
- Royal Prince Alfred Hospital; Sydney Australia
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9
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Arteria Lusoria: An Anomalous Finding during Right Transradial Coronary Intervention. Case Rep Cardiol 2016; 2016:8079856. [PMID: 27478652 PMCID: PMC4949336 DOI: 10.1155/2016/8079856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022] Open
Abstract
Arteria Lusoria or aberrant right subclavian artery (ARSA) is present in 0.6–1.4% of individuals. It typically remains clinically silent and is often discovered during angiographic procedures. The presence of ARSA can make a right transradial approach for coronary angiography and angioplasty technically more difficult. With the use of catheter support, we describe two cases in which a right transradial approach for catheterization was successful in the setting of ARSA. As such, the presence of ARSA does not warrant abandoning a transradial approach for coronary angiography and angioplasty.
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10
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Abualayem M, Hawatmeh A, Shittu M, Shamoon F. Aberrant right subclavian artery (arteria lusoria) diagnosed during transradial coronary catheterization. Quant Imaging Med Surg 2016; 6:328-30. [PMID: 27429920 DOI: 10.21037/qims.2016.05.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Mahmoud Abualayem
- Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA
| | - Amer Hawatmeh
- Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA
| | - Muhammed Shittu
- Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA
| | - Fayez Shamoon
- Department of Cardiology, Saint Michael's Medical Center, New York Medical College, New Jersey, USA
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11
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Sukumaran TT, Pillay M, Gopalakrishnan A. An Anomalous Right Subclavian Artery with a Retrotracheal Course: A Case Report. J Clin Diagn Res 2015; 9:AD01-2. [PMID: 26673689 PMCID: PMC4668395 DOI: 10.7860/jcdr/2015/14931.6722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/07/2015] [Indexed: 11/24/2022]
Abstract
An aberrant right subclavian artery arising as the last vessel of the arch of aorta is an uncommon anatomic anomaly with prevalence reported between 0.2% and 2.0%. In 80% of the cases the aberrant right subclavian artery takes a retro-oesophageal course to the right upper limb. During routine dissection of cadavers for teaching undergraduate medical students an anomalous retrotracheal right subclavian artery which is a very rare vascular anomaly was encountered in a 35-year-old male cadaver. The artery arose as the last branch of the arch of aorta and coursed to the right between the trachea and oesophagus. The presence of this vascular anomaly could be an unusual cause of dysphagia and breathing difficulty. The clinical significance and embryological aspects of this vascular variant is discussed in this paper.
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Affiliation(s)
- Tintu Thottiyil Sukumaran
- Lecturer, Department of Anatomy, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Minnie Pillay
- Clinical Professor, Department of Anatomy, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Asha Gopalakrishnan
- Lecturer, Department of Anatomy, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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12
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Patel TM, Shah S, Pancholy SB. Strategies to Traverse the Arm and Chest Vasculature. Interv Cardiol Clin 2015; 4:127-144. [PMID: 28582045 DOI: 10.1016/j.iccl.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article discusses different methods of working through arm and chest vasculature to increase the success rate of the transradial approach (TRA). Despite lower rates of bleeding and vascular complications as compared with the transfemoral approach, adoption of the TRA has been slow, particularly because of higher failure rates. Anatomic complexities of arm and chest vasculature play an important role in cases of TRA failure. Using a simple framework to classify the anatomic or functional problem and approaching these challenges in a logical sequence should facilitate management and increase the success rate for TRA.
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Affiliation(s)
- Tejas M Patel
- Apex Heart Institute, S. G. Road, Ahmedabad 380 054, India; Department of Cardiology, Sheth V.S. General Hospital, Smt. N.H.L. Municipal Medical College, Ellisbridge, Ahmedabad 380 006, India.
| | - Sanjay Shah
- Apex Heart Institute, S. G. Road, Ahmedabad 380 054, India; Department of Cardiology, Sheth V.S. General Hospital, Smt. N.H.L. Municipal Medical College, Ellisbridge, Ahmedabad 380 006, India
| | - Samir B Pancholy
- Department of Cardiology, The Wright Center for Graduate Medical Education, The Commonwealth Medical College, 501 Madison Avenue, Scranton, PA 18510, USA
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Polguj M, Chrzanowski Ł, Kasprzak JD, Stefańczyk L, Topol M, Majos A. The aberrant right subclavian artery (arteria lusoria): the morphological and clinical aspects of one of the most important variations--a systematic study of 141 reports. ScientificWorldJournal 2014; 2014:292734. [PMID: 25105156 PMCID: PMC4102086 DOI: 10.1155/2014/292734] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/22/2014] [Accepted: 05/06/2014] [Indexed: 12/20/2022] Open
Abstract
The most important abnormality of the aortic arch is arguably the presence of an aberrant right subclavian artery (arteria lusoria). If this vessel compresses the adjacent structures, several symptoms may be produced. The aim of the study is to present the morphological and clinical aspects of the aberrant right subclavian artery. Three different databases searched for a review of pertinent literature using strictly predetermined criteria. Of 141 cases, 15 were cadaveric and 126 were clinically documented. The gender distribution of the subjects was 55.3% female and 44.7% male. The mean age of the patients at symptoms onset was 49.9 ± 19.4 years for all patients but 54.0 ± 19.6 years and 44.9 ± 18.1 years for female and male subjects, respectively (P = 0.0061). The most common symptoms in this group were dysphagia (71.2%), dyspnea (18.7%), retrosternal pain (17.0%), cough (7.6%), and weight loss (5.9%). The vascular anomalies coexisting with an arteria lusoria were truncus bicaroticus (19.2%), Kommerell's diverticulum (14.9%), aneurysm of the artery itself (12.8%), and a right sided aortic arch (9.2%). In conclusion, compression of adjacent structures by an aberrant right subclavian artery needs to be differentiated from other conditions presenting dysphagia, dyspnea, retrosternal pain, cough, and weight loss.
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Affiliation(s)
- Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Łukasz Chrzanowski
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Jarosław D. Kasprzak
- Department of Cardiology, Medical University of Łódź, Kniaziewicza 33, 90-153 Łódź, Poland
| | - Ludomir Stefańczyk
- Department of Radiology, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Medical University of Łódź, Narutowicza 60, 90-136 Łódź, Poland
| | - Agata Majos
- Department of Radiological and Isotopic Diagnosis and Therapy, Medical University of Łódź, Żeromskiego 113, 90-549 Łódź, Poland
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14
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RIGATELLI GIANLUCA, DELL'AVVOCATA FABIO, VASSILIEV DOBRIN, DAGGUBATI RAMESH, NANJIUNDAPPA ARAVINDA, GIORDAN MASSIMO, AL AZZA KHALID, CARDAIOLI PAOLO, NGUYEN THACH. Strategies to Overcome Hostile Subclavian Anatomy during Transradial Coronary Angiography and Interventions: Impact on Fluoroscopy, Procedural Time, Complications, and Radial Patency. J Interv Cardiol 2014; 27:428-34. [PMID: 24815560 DOI: 10.1111/joic.12127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- GIANLUCA RIGATELLI
- Cardiovascular Diagnosis and Endoluminal Interventions; Rovigo General Hospital, Rovigo; Legnago Italy
| | - FABIO DELL'AVVOCATA
- Cardiovascular Diagnosis and Endoluminal Interventions; Rovigo General Hospital, Rovigo; Legnago Italy
| | - DOBRIN VASSILIEV
- Interventional Cardiology; National Heart Institute; Sofia Bulgaria
| | - RAMESH DAGGUBATI
- Brody School of Medicine at East Carolina University; Greenville North Carolina
| | - ARAVINDA NANJIUNDAPPA
- CAMC Vascular Center of Excellence; West Virginia University; Charleston West Virginia
| | - MASSIMO GIORDAN
- Cardiovascular Diagnosis and Endoluminal Interventions; Rovigo General Hospital, Rovigo; Legnago Italy
| | - KHALID AL AZZA
- Cardiology Department; St. Mary Medical Center; Hobart Indiana
| | - PAOLO CARDAIOLI
- Cardiovascular Diagnosis and Endoluminal Interventions; Rovigo General Hospital, Rovigo; Legnago Italy
| | - THACH NGUYEN
- Cardiology Department; St. Mary Medical Center; Hobart Indiana
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15
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Patel T, Shah S, Pancholy S, Deora S, Prajapati K, Coppola J, Gilchrist IC. Working through challenges of subclavian, innominate, and aortic arch regions during transradial approach. Catheter Cardiovasc Interv 2014; 84:224-35. [PMID: 24510527 DOI: 10.1002/ccd.25418] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/31/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of this review is to discuss different methods of working through subclavian, innominate, and aortic arch anatomical challenges to increase the success rate of transradial approach (TRA). BACKGROUND Anatomical challenges in the subclavian, innominate, and aortic arch regions are important reasons for failure of TRA. There is limited modern literature describing methods to overcome these challenges and reduce TRA failure. METHODS A number of primary subclavian, innominate, and aortic arch anatomical challenges are identified and management techniques to overcome them are discussed. RESULTS Subclavian, innominate, and aortic arch anatomical challenges can be divided into five subsets, including (1) tortuosity, (2) loop, (3) stenosis, (4) congenital aberrancy, and (5) combined challenges. In depth discussion with supportive examples for the identification and management of these challenges are provided. CONCLUSIONS Despite lower rates of bleeding and vascular complications as compared to transfemoral approach, the adoption of TRA has been relatively slow in part due to frustration from operator failure during the learning curve. Anatomical challenges of subclavian, innominate, and aortic arch regions play an important role in TRA procedural failure. Using a simple, conceptual, framework to classify the anatomical or functional problem and then applying a logical approach to these challenges can facilitate management and augment operator success rates for TRA.
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Affiliation(s)
- Tejas Patel
- Apex Heart Institute, Ahmedabad, India; Department of Cardiology, Sheth V.S. General Hospital and Smt. N.H.L. Municipal Medical College, Ahmedabad, India
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Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, Sabate M, Mauri-Ferré J, Huber K, Niemelä K, Haude M, Wijns W, Dudek D, Fajadet J, Kiemeneij F. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EUROINTERVENTION 2013; 8:1242-51. [PMID: 23354100 DOI: 10.4244/eijv8i11a192] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.
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Affiliation(s)
- Martial Hamon
- Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandie, France.
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17
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Kassimis G, Sabharwal N, Patel N, Banning A. Aberrant Right Subclavian Artery Hematoma Following Radial Catheterization. JACC Cardiovasc Interv 2013; 6:636-7. [DOI: 10.1016/j.jcin.2012.12.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/12/2012] [Accepted: 12/21/2012] [Indexed: 10/26/2022]
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18
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Bennett AL, Cock C, Heddle R, Morcom RK. Dysphagia lusoria: a late onset presentation. World J Gastroenterol 2013; 19:2433-6. [PMID: 23613640 PMCID: PMC3631998 DOI: 10.3748/wjg.v19.i15.2433] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/19/2013] [Accepted: 03/06/2013] [Indexed: 02/06/2023] Open
Abstract
Dysphagia lusoria is a term used to describe dysphagia secondary to vascular compression of the oesophagus. The various embryologic anomalies of the arterial brachial arch system often remain unrecognised and asymptomatic, but in 30%-40% of cases can result in tracheo-oesophageal symptoms, which in the majority of cases manifest as dysphagia. Diagnosis of dysphagia lusoria is via barium swallow and chest Computed tomography scan. Manometric abnormalities are variable, but age-related manometric changes may contribute to clinically relevant dysphagia lusoria in patients who present later in life. Our report describes a case of late-onset dysphagia secondary to a right aortic arch with an aberrant left subclavian artery, which represents a rare variant of dysphagia lusoria. The patient had proven additional oesophageal dysmotility with solid bolus only and a clinical response to dietary modification.
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19
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Han SH, Kim SY, Park HK, Park JS. A Case of Aberrant Right Subclavian Artery (Arteria Lusoria) with Chest Tightness and Coughing. Yeungnam Univ J Med 2012. [DOI: 10.12701/yujm.2012.29.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Seung-Hee Han
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Su-Young Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hye-Kyong Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jong Sung Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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20
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Yiu KH, Chan WS, Jim MH, Chow WH. Arteria lusoria diagnosed by transradial coronary catheterization. JACC Cardiovasc Interv 2010; 3:880-1. [PMID: 20723863 DOI: 10.1016/j.jcin.2010.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 02/05/2010] [Indexed: 12/20/2022]
Affiliation(s)
- Kai-Hang Yiu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China
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21
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Burzotta F, Trani C, De Vita M, Crea F. A new operative classification of both anatomic vascular variants and physiopathologic conditions affecting transradial cardiovascular procedures. Int J Cardiol 2010; 145:120-2. [DOI: 10.1016/j.ijcard.2009.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
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Abstract
This article reviews the current technique of coronary angiography, focusing on the choice of arterial access site; navigation from the arterial access site to the ascending thoracic aorta; cannulation of the native coronary arteries in their normal, variant, and anomalous locations; and cannulation of saphenous vein and arterial graft conduits. The authors conclude that, although no didactic training can substitute for the hands-on apprenticeship obtained during general cardiology and interventional cardiology fellowships, the intellectual elements fundamental to coronary angiography outlined here will result in a more efficient, effective, and safe procedure for patients.
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Affiliation(s)
- Ivan P Casserly
- University of Colorado Hospital, Anschutz Medical Campus, Leprino Building, Room #524, 12401 E. 17th Ave., P.O. Box 6511, Aurora, CO 80045, USA.
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23
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Huang IL, Hwang HR, Li SC, Chen CKH, Liu CP, Wu MT. Dissection of arteria lusoria by transradial coronary catheterization: a rare complication evaluated by multidetector CT. J Chin Med Assoc 2009; 72:379-81. [PMID: 19581145 DOI: 10.1016/s1726-4901(09)70391-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
An aberrant right subclavian artery (arteria lusoria) arising from the descending thoracic aorta is an uncommon congenital variant that occurs in about 0.2-1.7% of the population. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, we present the first report of an iatrogenic dissection of arteria lusoria during transradial coronary angiography evaluated by multidetector computed tomography. Computed tomography is useful for assessing the severity and extension of the dissection to guide the clinical management of this complication.
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Affiliation(s)
- I-Lun Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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Youssef A, Hsieh YK, Cheng CI, Wu CJ. A single transradial guiding catheter for right and left coronary angiography and intervention. EUROINTERVENTION 2008; 3:475-81. [DOI: 10.4244/eijv3i4a85] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Abstract
The aberrant right subclavian artery is present in 0.4 per cent of the population. It is usually asymptomatic and only rarely causes symptomatic esophageal compression, a condition known as dysphagia lusoria. It was diagnosed in one of 920 patients undergoing diagnostic endoscopy (223 for dysphagia) and characterized by CT scan. It is important for clinicians to be aware of this condition and that the artery may be visible at endoscopy.
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26
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Kelly MD. Dysphagia lusoria. ANZ J Surg 2007; 77:1025. [PMID: 17931276 DOI: 10.1111/j.1445-2197.2007.04305.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Comparison of immediate and followup results between transradial and transfemoral approach for percutaneous coronary intervention in true bifurcational lesions. Chin Med J (Engl) 2007. [PMID: 17442199 DOI: 10.1097/00029330-200704010-00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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Cantor WJ, Puley G, Natarajan MK, Dzavik V, Madan M, Fry A, Kim HH, Velianou JL, Pirani N, Strauss BH, Chisholm RJ. Radial versus femoral access for emergent percutaneous coronary intervention with adjunct glycoprotein IIb/IIIa inhibition in acute myocardial infarction--the RADIAL-AMI pilot randomized trial. Am Heart J 2005; 150:543-9. [PMID: 16169338 DOI: 10.1016/j.ahj.2004.10.043] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 10/18/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transradial percutaneous coronary intervention (PCI) results in fewer vascular complications, earlier ambulation, and improved patient comfort. Limited data exist for radial access in acute myocardial infarction, where reperfusion must occur quickly. METHODS In a multicenter pilot trial, 50 patients with myocardial infarction requiring either primary or rescue PCI were randomized to radial or femoral access. All operators had previously performed at least 100 transradial cases. Procedure times were prospectively recorded. RESULTS Thrombolysis was used in 66% of the cases and glycoprotein IIb/IIIa inhibitors in 94%. Crossover from radial to femoral access was required in one case. Percutaneous coronary intervention was performed in 47 patients, with stenting in 45. One procedural failure occurred with radial access because of inability to cross the occlusion. The time from local anesthesia to first balloon inflation was 32 (25th percentile 26, 75th percentile 38) minutes for radial access and 26 (22, 33) minutes for femoral access (P = .04). There were no significant differences in contrast use or fluoroscopy time. No patient experienced major bleeding or required transfusion. Doppler studies demonstrated 2 asymptomatic radial occlusions and 2 pseudoaneurysms (1 from each group). One patient in the femoral group died 2 days after PCI. At 30 days, there were no strokes or reinfarctions and no patient required bypass surgery or repeat PCI. CONCLUSIONS Primary and rescue PCI can be performed with high success rates using either radial or femoral access. Although radial access was associated with a longer time to first balloon inflation, the difference was small and likely not clinically significant. In patients without shock, major bleeding and vascular complications are infrequent with either access site despite the high use of thrombolysis and glycoprotein IIb/IIIa inhibitors.
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Affiliation(s)
- Warren J Cantor
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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29
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Rondán J, Lozano I, Morís C, Martín M, Avanzas P, Suárez E. Cateterismo cardíaco por vía radial derecha con catéter Judkins izquierdo. Estudio prospectivo. Rev Esp Cardiol 2005. [DOI: 10.1157/13077239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Lee DH, Ahn JH, Jeong SS, Eo KS, Park MS. Routine transradial access for conventional cerebral angiography: a single operator's experience of its feasibility and safety. Br J Radiol 2004; 77:831-8. [PMID: 15482994 DOI: 10.1259/bjr/89933527] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study is to describe a single operator's experience with the feasibility and safety of transradial access in conventional cerebral angiography. 153 patients were enrolled consecutively. Among them, 20 patients were not suitable for transradial access. A Simmons catheter was used. Haemostasis was achieved using a compressive dressing of the wrist. We analysed the success rates of the arterial puncture and the successful catheterization rate for each supra-aortic vessel as well as all complications. The arterial access was successful in 96.3%. The supra-aortic vessels were catheterized with success rates of 99.2% (127/128) for the left subclavian artery and 100% for the other arteries. The mean procedure time was 19.3 min (range 10-55 min). Haemostasis was successfully achieved in every case. The most frequent complication was arm pain which occurred in 37 patients (28.9%). In conclusion, transradial selective cerebral angiography with a reversed-angle catheter is technically feasible and safe. It might be helpful in imaging follow-up of patients with arterial stenting or coil embolisation of the cerebral aneurysms. Modification of the catheter design is required to improve the selectivity of the supra-aortic branches.
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Affiliation(s)
- D H Lee
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Sacheon-myon, Gangneung-si, Gangwon-do, 210-711, Korea
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31
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Cha KS, Kim MH, Kim HJ. Prevalence and clinical predictors of severe tortuosity of right subclavian artery in patients undergoing transradial coronary angiography. Am J Cardiol 2003; 92:1220-2. [PMID: 14609604 DOI: 10.1016/j.amjcard.2003.07.038] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated the prevalence and clinical predictors of severe tortuosity of the right subclavian artery (RSA) in 2,341 consecutive patients who underwent transradial coronary angiography as well as the feasibility and safety of a technique to complete transradial catheterization. Severe tortuosity of the RSA was seen in approximately 10% of these patients, and clinical predictors included systemic hypertension, female gender, older age, nonsmoker, short stature, and high body mass index. Guidewire replacement with a stiff guidewire is reliable and safe for completing transradial angiography in most patients with a tortuous RSA.
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Affiliation(s)
- Kwang Soo Cha
- Department of Cardiology, Dong-A University Medical Center and College of Medicine, Busan, South Korea.
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Hildick-Smith DJR, Walsh JT, Lowe MD, Shapiro LM, Petch MC. Transradial coronary angiography in patients with contraindications to the femoral approach: An analysis of 500 cases. Catheter Cardiovasc Interv 2003; 61:60-6. [PMID: 14696161 DOI: 10.1002/ccd.10708] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The transradial approach to coronary angiography is considered by some to be a route of choice, by others to be a route that should be used only where there are relative contraindications to the femoral approach. We present the largest series to date of patients in whom transradial coronary angiography was undertaken specifically because of contraindications to the femoral approach. Since 1995, patients at this cardiothoracic center have been considered for a transradial approach to coronary angiography if there were relative contraindications to the femoral route. Data from 500 patients was prospectively collected. Patients were aged 66 +/- 9 years; 72% were male. Indications for the radial approach included peripheral vascular disease (305), therapeutic anticoagulation (77), musculoskeletal (59), and morbid obesity (32). Sixty-eight patients (14%) required a radial procedure following a failed femoral approach. Access was right radial 291 (58%), left radial 209 (42%). Eighteen operators were involved, but two operators undertook 355 (71%) of the cases. Catheter gauge was 6 Fr (n = 243; 49%), 5 Fr (219; 43%), and 4 Fr (29; 6%). The procedure was successful in 463 cases [92.6%; 88.2% for nonmajority vs. 94.4% (P < 0.05) for the two majority operators]. Success in males (93.6%) significantly exceeded that in females (90.1%; P < 0.05). In-catheter-laboratory duration was 45 +/- 17 min; fluoroscopy time, 7.5 +/- 6 min; radiation dose, 40 +/- 23 CGy. The procedure was without incident in 408 cases (82%). There were procedural difficulties in 18% of cases, including radial artery spasm (12%) and vasovagal response (5%). The incidence was higher with 6 Fr catheters (23%) than with 5/4 Fr (15%; P < 0.05). Major procedural complications occurred in three cases: brachial artery dissection in one and cardiac arrest in two. Postprocedure major vascular complications numbered three: claudicant pain on handgrip in one, ischemic index finger (with subsequent terminal phalanx amputation due to osteomyelitis) in one, and ischemic hand for 4 hr in one. Patients with contraindications to the femoral approach form a high-risk group. In these patients, transradial cardiac catheterization can be performed successfully and with a low risk of major complications. Minor adverse features remain frequent, occurring in one in five cases, though difficulties are minimized both with increasing operator experience and smaller sheath diameter.
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Grollman JH. The many faces of the anomalous left aortic arch. Catheter Cardiovasc Interv 2001; 54:202-3. [PMID: 11590684 DOI: 10.1002/ccd.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J H Grollman
- Memrad Medical Group, Department of Radiology, Little Company of Mary Hospital, Torrance, CA, USA
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