Incidental angiographic finding of extended chronic brachial artery occlusion: an uncommon but unavoidable cause of transradial catheterisation failure

The recent widespread adoption of radial access in performing percutaneous coronary interventions has determined a greater reduction of vascular complications and related bleedings than traditional femoral access, even leading to favourable impact on clinical outcome through a significant reduction of combined efficacy and safety clinical end-point in a recent large randomised trial (1). Besides, the progressive diffusion of slender radial approach with dedicated vascular sheaths and small diameter catheters have almost always allowed to accomplish coronary procedures even in case of adults with small radial artery, such in elders, in females or in subjects of small body surface, particularly prevalent in some racial population (South-East Asians). However, in rare cases, anatomical variants of radial calibre and course and anomalies of brachio-cephalic trunk are responsible of failure of radial access or may determine difficult catheter manipulation even inducing to abandon vascular access.