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Analysis of Peripheral Arterial Bends that interfere with Coronary Catheterization.

Naoki Masuda, Takashi Matsukage, Nobuhiko Ogata, Yoshihiro Morino, Teruhisa Tanabe, Yuji Ikari.

OBJECTIVES: The aim of this study was to analyze the characteristics of peripheral arterial bends that interfere with coronary catheterization.

BACKGROUND: Complex aortic and peripheral arterial bends are important factors in unsuccessful coronary catheterization.

METHODS: We classified peripheral arterial bends based on the difficulty of coronary catheterization: no bend, type A: easy; type B1: difficult but possible; type B2: difficult but possible with assistance of a device such as a long sheath; type C: impossible. We analyzed 1,626 consecutive cardiac catheterizations.

RESULTS: Reproducibility (?± 1 grade) was 98.9% in 256 patients undergoing multiple procedures from the same approach site. Peripheral arterial bend class distribution was as follows: no bend: 76.4%, type A: 12.5%, type B1: 5.0%, type B2: 5.5%, and type C: 0.6%. Fluoroscopy time and contrast volume were significantly greater in type B2/C (9.6 ?± 6.26 min versus 13.8 ?± 8.9 min, p < 0.0001 and 142.0 ?± 38.8 ml versus 168.4 ?± 53.6 ml, p < 0.0001, respectively). There were no differences in the distribution of types B and C by approach site; femoral approach, 6.4%; right upper limb approach, 6.1%; and left upper limb approach, 5.0%. Furthermore, in the patients who underwent multiple catheterizations from different approach sites, the arterial bend classes were similar. Predictors of a type B2/C arterial bend were mainly atherosclerotic risk factors, suggesting that longitudinal arterial elongation is the major cause of arterial bends.

CONCLUSIONS: Peripheral arterial bends are a feature of the individual patient, not of the approach site.

J INVASIVE CARDIOL 2010;22:197â??203.