Chapter 15: Normal Anatomy and Vascular Anomalies of the Upper Extremity

The transradial approach for percutaneous coronary interventions has seen steady increases in global adoption since the first reports of transradial coronary angiography by Lucian Campeau in 1989 and transradial percutaneous coronary intervention (PCI) by Ferdinand Kiemeneij in 1992. A thorough understanding of upper extremity vascular anatomy, along with the commonly encountered vascular anomalies is requisite not only for advancing an individual’s radial practice to “default approach” status, but also for avoidance of complications.

Normal Radiobrachial Arterial Anatomy

Transradial approach derives its major safety advantages over transfemoral and/or transbrachial techniques due in large part to the unique vascular anatomy of the forearm. The radial artery is a muscular artery lying beneath the antebrachial fascia between the brachioradialis muscle and the flexor carpi radialis. The artery commences at the bifurcation of the brachial artery approximately 1 cm below the antecubital fossa and courses along the lateral aspect of the forearm to the wrist, where it passes deep to the tendons of the abductor pollicis longus and the extensor pollicis brevis across the anatomic snuffbox.

Isida Byku, MD and Sandeep Nathan, MD, MSc