Overcoming vascular anatomic challenges to cardiac catheterization by the radial artery approach: Specific techniques to improve success

Anatomical variations in the peripheral vasculature can result in decreased procedural success rates for cardiac catheterization performed through the radial artery approach. We describe four categories of vascular challenges encountered in our catheterization laboratory: severe spasm, severe tortuosity, vascular stenosis, and congenital anatomical variations (e.g., accessory radial artery, radioulnar loop). For each situation, we provide a case report illustrating techniques that allowed for successful completion of the case. (C) 2002 Wiley-Liss, Inc.