Korean Circ J.  2009 Aug;39(8):304-309. 10.4070/kcj.2009.39.8.304.

The Feasibility of Bypass Graft Angiography by Right Radial Access

• Lee JH
• Kim MJ
• Cha KS
• Choi JH
• Lee SY
• Nam YH
• Park JS
• Chung SH
• Kum DS
• Park TH
• Kim MH
• Kim YD

• KMID: 2225679
• DOI: http://doi.org/10.4070/kcj.2009.39.8.304

Abstract

BACKGROUND AND OBJECTIVES
Left transradial coronary angiography may result in damage of both radial arteries in patients who experienced right radial access. In some patients, the left radial artery has been used as a graft. We investigated whether graft angiography using right radial access is feasible in patients with bypass surgery to preserve the left radial artery as a future graft. SUBJECTS AND METHODS: A total of 109 consecutive patients with bypass surgery who had undergone right radial access underwent graft angiography via the same access. RESULTS: Sixteen (15%) patients were excluded because of the presence of a severely tortuous right subclavian artery. Bypass graft angiography via right radial or brachial access was completed successfully in 90 (97%) out of 93 patients. In 3 (3%) of patients, femoral access was needed to complete the angiography. Saphenous vein grafts were cannulated selectively in 150 (90%) of 167 grafts with satisfactory image quality and not found even on the aortogram in the other 17 (10%) grafts. Ninety-two (89%) out of 103 left mammary grafts were cannulated selectively or semi-selectively using a modified Simmons catheter, resulting in satisfactory image quality. The other 11 (11%) grafts were visualized non-selectively using a Judkins Left catheter, and resulting in acceptable image quality in 10 (91%) grafts. There were no procedure-related complications. CONCLUSION: Graft angiography via right radial access can be performed reliably in most patients that lack severe subclavian tortuosity.

Keyword

Coronary artery bypass; Angiography; Radial artery; Mammary arteries; Saphenous vein

MeSH Terms

Angiography
Catheters
Coronary Angiography
Coronary Artery Bypass
Humans
Mammary Arteries
Radial Artery
Saphenous Vein
Subclavian Artery
Transplants

Figure

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  Fig. 1 Modified Simmons catheters with a newly angled tip and 3 different curve lengths (7.5 cm, 7.7 cm, and 8.5 cm).22)

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  Fig. 2 Selective angiography of saphenous vein grafts with Amplatz Left (AL) and Right (AR) catheters.

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  Fig. 3 Semi-selective angiography of a left mammary graft with a modified Simmons catheter. Although the catheter tip is not cannulated selectively (arrow, A), the image quality is excellent in the anastomosis site (B) and collateral vessel (arrow, C).

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  Fig. 4 Non-selective angiography of the left mammary graft with a Judkins Left catheter.21)

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  Fig. 5 An algorithm proposed for choosing access sites in patients who have had coronary artery bypass surgery. LIMA: left internal mammary artery, IMA: internal mammary artery.

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