Transradial cardiac catheterization (TRCC) has unique technical challenges such as access difficulty related to anatomical variations and/or radial artery (RA) spasm. We sought to evaluate the incidence of anatomical variations of the RA and whether they would affect RA spasm and procedural achievement of TRCC. A total of 744 consecutive patients who underwent TRCC were analyzed by routine radial arteriography. Anatomical variations were defined as abnormal origin of the RA and/or radioulnar loop and/or tortuous configuration. RA spasm was defined as >75% stenosis at first radial arteriography. Overall, anatomical variations were noted in 68 patients (9.1%), including 39 cases of abnormal origin (5.2%), 11 cases of radioulnar loop (1.5%), and 42 cases of tortuous configuration (5.6%). Transradial procedures failed in 26 patients (3.5%), and more frequently in patients with anatomical variation than in those with normal anatomy (23.5% vs 1.5%, P < 0.001). Importantly, on multivariate analysis the presence of anatomical variation was a distinct predictor of transradial procedure failure (odds ratio (OR) 17.80; 95% CI 7.55-43.73; P < 0.001). RA spasm was observed in 83 patients (11.2%), and more frequently in patients with anatomical variation than in those with normal anatomy (35.3% vs 8.7%, P < 0.001). Anatomical variation (OR 4.74; 95% CI 2.61-8.47; P < 0.001) and female gender (OR 2.23; 95% CI 1.01-4.73; P = 0.041) were distinct predictors of RA spasm. Anatomical variations were observed in 9.1% of the patients, and strongly correlated with RA spasm and procedural achievement of TRCC.
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