|IMAGES IN CARDIOLOGY
|Year : 2021 | Volume
| Issue : 4 | Page : 150
Incidentally detected “tram track forearm arteries” in an elderly
Gauravkumar Divani MD , Shivank Gupta MD , A Shaheer Ahmed MD DM DNB
Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
|Date of Submission||18-May-2021|
|Date of Acceptance||21-May-2021|
|Date of Web Publication||24-Dec-2021|
Dr. A Shaheer Ahmed
Department of Cardiology, 7th Floor, Super Speciality Block, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Divani G, Gupta S, Ahmed A S. Incidentally detected “tram track forearm arteries” in an elderly. J Clin Prev Cardiol 2021;10:150
An 85-year-old male presented with unstable angina and few episodes of presyncope. Electrocardiogram revealed complete heart block with narrow QRS complex escape rhythm. Echocardiography showed normal left ventricular function and mitral annular calcification. He was taken up for coronary angiography by right radial artery access. He had a normal volume radial artery pulse. After puncturing the radial artery, a 0.021” guidewire was inserted. However, there was difficulty in inserting the 6Fr radial artery sheath. Fluoroscopy of the right forearm was done which revealed dense calcification of the radial and ulnar arteries. Radial artery angiogram revealed a patent lumen and hence we proceeded with the coronary angiogram from right radial access [Figure 1]. Radial artery calcification is seen in old age, chronic kidney disease, diabetes mellitus, vasculitis, and conditions associated with hypercalcemia. The calcification in peripheral arteries can be either in the tunica intima or media and has implications in choosing conduits for coronary artery bypass grafting. Intimal calcification is usually seen associated with an atherosclerotic plaque and might be associated with luminal narrowing. Medial calcification as seen in old age is not associated with plaque in the vicinity and does not narrow the vessel lumen. The radial artery is one of the conduits used for coronary artery bypass grafting. The presence of dense calcification precludes the usage of radial arterial graft.
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