How to manage difficult anatomic conditions affecting transradial approach coronary procedures?

The adoption of transradial approach for percutaneous coronary diagnostic and interventional procedures is known to reduce access-site complications. However, anatomic variants of brachial-radial axis, axillary-subclavian-anonymous axis and aortic arch may obstacle successful completion of transradial procedures. In the present paper, we discuss how to diagnose and manage the possible obstacles occurring at the different steps of transradial diagnostic and interventional procedures.