Challenges in coronary angiography through radial artery access due to anatomic variations: A single-center experience

Background: Radial artery (RA) access has become common in cardiac catheterization due to fewer vascular complications and MACE compared to transfemoral approach (TFA). However, anatomic variations are more common in the upper-extremity. Methods: We performed a single-center retrospective analysis of 926 patients from January 2010 to January 2023 who underwent coronary angiography through transradial approach (TRA) via the right upper-extremity where RA angiogram was performed. Outcomes included anatomic variations, sociodemographic and health characteristics, adverse outcomes, and procedural challenges. Multivariate logistic regression was utilized to estimate the odds ratio of the association between anatomic variations and adverse outcomes and procedural challenges. Results: Our analysis included 926 patients with a mean age of 59.9 years. Approximately 32.3 % of patients had at least one anatomic variation. Individual variations included 14.4 % radial tortuosity, 12 % high bifurcation, 11.9 % M-sign, and 1 % RA loops. These patients were older (P < 0.001) and more likely to have hyperlipidemia (P = 0.049). They had high odds of high contrast dose (>73.7 mL) (OR = 1.73, P < 0.001), long fluoroscopy time (>10.7 mins) (OR = 2.02, P < 0.001), high radiation exposure (>1120 mGy) (OR = 2.47, P < 0.001), difficulty engaging coronary arteries (OR = 2.70, P < 0.001), and transfer to TFA (OR = 4.89, P < 0.001). Females (OR = 2.89, P < 0.001) and smaller RA size (OR = 2.61, P < 0.001) were associated with spasm. Major complications were not significant. Conclusions: We found a high prevalence of anatomic variations in the upper-extremity vasculature. They were associated with high odds of high contrast dose, long fluoroscopy time, high radiation exposure, and procedural challenges during TRA coronary angiography. The rate of major complications was not significant in these patients.