Author + information
- Received May 29, 2013
- Accepted June 6, 2013
- Published online March 1, 2014.
- Isaac R. Whitman, MD∗ ( and )
- Andrew J. Boyle, MBBS, PhD
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California
- ↵∗Reprint requests and correspondence:
Dr. Isaac R. Whitman, University of California, San Francisco, 505 Parnassus Avenue, M1174, San Francisco, California 94143.
A 47-year-old man with prior right ulnar collateral ligament reconstruction presented with angina and was referred for cardiac catheterization. Right radial artery angiogram was normal (Fig. 1A, Online Video 1). A J-tip guidewire met resistance just above the elbow. A subsequent brachial angiogram revealed an extremely tortuous recurrent brachial artery loop (Figs. 1B and 1C, Online Videos 2 and 3). The transradial approach is increasingly common in coronary angiography, reducing the risk of access site complications (1,2). Full radial artery loops occur in 1% to 2% of patients, and can often be straightened with a guidewire (3,4). However, the prevalence and challenges presented by brachial artery loops are not discussed in the literature. Furthermore, it is not known whether these tend to occur unilaterally or bilaterally, so there are no data guiding the choice between contralateral radial artery versus femoral artery as the alternative access site. Our decision was to attempt contralateral radial access. That decision proved prudent, as the patient's left upper extremity demonstrated normal anatomy (Fig. 1D, Online Video 4).
For accompanying videos, please see the online version of this paper.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 29, 2013.
- Accepted June 6, 2013.
- American College of Cardiology Foundation
- Dehmer G.J.,
- Weaver D.,
- Roe M.T.,
- et al.
- Romagnoli E.,
- Biondi-Zoccai G.,
- Sciahbasi A.,
- et al.
- Lo T.S.,
- Nolan J.,
- Fountzopoulos E.,
- et al.