A new operative classification of both anatomic vascular variants and physiopathologic conditions affecting transradial cardiovascular procedures.

Transradial approach is known to reduce access-site complications of coronary procedures. However, the diffusion of transradial approach in the interventional cardiology community is limited by its higher failure rate compared to transfemoral. Transradial approach failures are mainly caused by a series of anatomic variants which may be encountered in the upper limb arteries. Such anatomic variants have been variously classified based on postmortem studies or systematic angiographic studies. We propose a simplified "operative" classification of anatomic vascular variants and physiopathologic conditions of the arterial axis, from radial to aortic root, possibly affecting transradial cardiovascular procedures.