Gilchrist IC - Anatomy of radial and brachial arteries
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Understanding the anatomy of the radial, brachial and subclavian arteries
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Gilchrist IC - Anatomy of radial and brachial arteries
- 1. Understanding The Anatomy Of The Radial, Brachial & Subclavian Arteries Ian C Gilchrist, MD, FACC, FSCAI Professor of Medicine Penn State’s Hershey Medical Center Heart & Vascular Institute Hershey, PA
- 3. Adventure of Something New Source: canberra.edu.au Radial anatomy is never boring TRAC 2013
- 4. Gunther von Hagens Basic Anatomy Radial Diameter Velasco. J Invasive Cardiol 20 12;24(7):339-341 TRAC 2013
- 5. Upper Arm Vascular Genesis Subclavian: 4th aortic arch Distal Subclavian: 7th cervical artery Axillary & Brachial Retroesophageal Subclavian 1 1. 2. Tortuous Subclavian 2 Quesada R. J Invasive Cardiol June 2011 Supplement Matsukage et al. J Invasive Cardiol 2011;23:E153–E155 TRAC 2013
- 6. Lower Arm Vascular Formation • Initial blood islands coalesce into vascular plexus around primordial muscle, nerves & bone • Plexus matures discrete vasculature thru selective hypertrophy & atrophy resulting in adult form • Local developmental influences result in a variety of final radial/ulnar configurations Diagram adapted in part from http://www.revespcardiol.org/imatges/ TRAC 2013
- 7. Normal Arm Arterial System Axillary Artery Biceps Brachii Muscle Brachial Artery Brachioradialis Muscle Radial Artery Ulnar Artery Adapted from Jelev L, Cardiovasc Intervent Radiol 2008;31:1008 TRAC 2013
- 8. Reality: Anatomical Variability 1540 patients-96.8% success, high-volume radial operators, United Kingdom Catheter in accessory radial Brachial artery Radial Loop (2.3%) Tortuosity (2.0%) High Radial Origins (7.0%) Anatomic variation associated with >3/4 of procedural failures Lo, Nolan et al, Heart 2009;95:410-415. TRAC 2013
- 9. Framework of Understanding 1. Where is the origin of the Radial Artery? antecubital, brachial, axillary 2. If Origin above the antecubital, then is there a cubital crossover? 3. If there is a cubital connection, what is the configuration of the connection? straight, loop, complex TRAC 2013
- 10. Normal Arm Arterial System Axillary Artery Brachial Artery Radial Artery Ulnar Artery Adapted from Jelev L, Cardiovasc Intervent Radiol 2008;31:1008 TRAC 2013
- 11. Development of Radial Origin Simplistic View Level of the Elbow Juvenile form Common Adult form Adapted McMurrich, The Development of the Human Body, 1920 TRAC 2013
- 12. Implication of Hi-Radial Origins Unusual courses (tortuosity), no effect on passage Radial-Axillary Junction Radial-Brachial Junction Adapted from Jelev L, Cardiovasc Intervent Radiol 2008;31:1008 Superficial Radial With High Junction TRAC 2013
- 13. Angiographic Findings Left arm of 92 yo woman with aortic stenosis Source: I Gilchrist Penn State 2013 TRAC 2013
- 14. Framework of Understanding 1. Where is the origin of the Radial Artery? antecubital, brachial, axillary 2. If Origin is above the antecubital, then is there a cubital crossover? TRAC 2013
- 15. High Radial Junction with Crossover No crossover Crossover: Potential for difficult passage & complications Adapted from Jelev L, Cardiovasc Intervent Radiol 2008;31:1008 TRAC 2013
- 16. Hazard of the Crossover Tight Fit Tight Turn Adapted from Jelev L, Cardiovasc Intervent Radiol 2008;31:1008 TRAC 2013
- 17. Balance of Cubital Crossover No Crossover Minimal Balanced Dominant Remnant Adapted from Hamon & McFadden (ed), Transradial Interventions 2nd ed, ISBN 978-2-9520202-1-3. TRAC 2013
- 18. Framework of Understanding 1. Where is the origin of the Radial Artery? antecubital, brachial, axillary 2. If Origin above the antecubital, then is there a cubital crossover? 3. If there is a cubital connection, what is the configuration of the connection? straight, loop, complex TRAC 2013
- 19. Junction vs Crossover ©icg2013 40 yo with cardiomyopathy Ideal Junction TRAC 2013
- 20. Examples of Crossover Adapted from: Cocchi, A. (1891) Atti dell Accademia dei Fisocritici in Siena, Ser. 4., 3:247-261. TRAC 2013
- 21. Radial Loops ©icg2013 J Invasive Cardiol 2010;22:536–540 ©icg2013 Adapted from Jelev L, Cardiovasc Intervent Radiol 2008;31:1008 TRAC 2013
- 22. Summary Expect variability Develop a framework of understanding -Origin of the radial? -Is there a cubital connection? -If so, what is its characteristic? If indoubt, take a limited angiogram Knowledge can be a powerful solution to the problem http://www.ohcaptain.com/2010/05/insights-from-road.html TRAC 2013
- 23. Thank you EMAIL ALWAYS WELCOME: ICG1@PSU.EDU TRAC 2013