Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention
Authors: Li Lang , Zeng Zhi-yu , Zhong Ji-ming , Wu Xiang-hong , Zeng Shu-yi , Tang Er-wen , Chen Wei , Sun Yu-han 
Published: January 2024

Background
More and more percutaneous coronary intervention were done from radial artery approach. But the great limitation of radial artery approach and main failure cause of transradial coronary intervention is smaller size and more variations of a radial artery approach. The aim of the study is to explore the features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention.

Methods
A total of 1400 patients who underwent scheduled first time transradial coronary angiography between July 2007 and September 2010 were enrolled. Radial arteriography was performed in all patients to detect the anatomical variations of this vessel. All patients' radial and ulnar artery inner diameters were measured using a computer assisted quantification method. A detailed patient history was recorded. Multivariate Logistic regression analysis was performed to evaluate the predictive value of variables (including age, gender, ethnicity, height, weight, body mass index, smoking, diabetes, hypertension and dyslipidemia) in arterial tortuosities and variations of this vessel.

Results
In southern Chinese populations, there were no significant differences in the diameters of the forearm arteries: the mean radial artery inner diameter was (3.04±0.43) mm in ethnic Han Chinese and (3.05±0.42) mm in ethnic Zhuang Chinese, P >0.05), the mean ulnar artery inner diameter was (3.03±0.38) mm in Han Chinese and (3.05±0.36) mm in Zhuang Chinese, P >0.05). It was estimated that the inner diameter of the radial artery was not smaller than a 6F Cordis sheath in 86.1% of male patients and in 57.0% of female patients, and not smaller than a 7F Cordis sheath in 59.3% of male patients and 24.9% of female patients. The factors found to positively affect the size of the radial artery were sex (b
j=0.309, P <0.01), weight (b
j=0.103, P <0.01), and diabetes mellitus (b
j= -0.088, P <0.01) was found to negatively affect radial artery size. Arterial tortuosities occurred in 12.1% of patients and arterial variations in 4.1%. The incidence of tortuosities and variations included radial artery tortuosity (3.6%), high origin of radial artery (1.7%), radial artery loop (0.6%), double radial artery (0.1%), brachial artery tortuosity (0.4%), double brachial artery (0.1%), subclavian artery tortuosity (5.4%), small subclavian artery (0.4%), right retro-esophageal subclavian artery (0.6%), brachiocephalic trunk tortuosity (2.8%), small brachiocephalic artery (0.1%), and brachiocephalic artery anomaly (0.4%). For people in Guangxi province, tortuosities of the subclavian artery and radial artery are the most common among the vascular tortuosities of the radial artery approach. The overall rate of transradial procedural success was 96.1%. Procedural failure was more common in patients with anomalous radial artery approach than in patients with normal radial artery approach (22.8% vs. 1.8%, P=0.000). According to multivariate Logistic regression analysis, age (OR=2.695, 95% CI 2.232-3.253, P=0.000), female gender (OR=5.127, 95% CI 3.000-8.762, P=0.000), height (OR=0.612, 95% CI 0.465-0.807, P=0.000), body mass index (OR=2.377, 95% CI 1.834-3.082, P=0.000), hypertension (OR=1.668, 95% CI 1.132-2.458, P=0.010), hyperlipidemia (OR=1.273, 95% CI 1.425-2.049, P=0.034) and smoking (OR=5.750, 95% CI 3.636-9.093, P=0.000), were independently associated with arterial tortuosities of the radial artery approach. Female gender was independently associated with arterial variations of the radial artery approach (OR=3.613, 95% CI 3.208-7.826, P=0.000).

Conclusions
The diameters of the radial and ulnar arteries between the Han people and the Zhuang people in southern Chinese populations are similar. In a transradial operation, the most southern Chinese populations, the use of a 6F sheath and guiding catheter is safe, and using a 7F sheath and guiding catheter is feasible in some selected patients. Radial arterial tortuosities and variations in southern Chinese populations are relatively common and are a significant cause of the failure of transradial coronary procedure. Old age, female gender, short stature, high body mass index, hypertension, hyperlipidemia and smoking, were independently associated with an increased risk of arterial tortuosity. In addition, female gender was an independent predictor of arterial variations.