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IMAGES IN CARDIOLOGY
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 150

Incidentally detected “tram track forearm arteries” in an elderly


Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Date of Submission18-May-2021
Date of Acceptance21-May-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Dr. A Shaheer Ahmed
Department of Cardiology, 7th Floor, Super Speciality Block, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcpc.jcpc_32_21

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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

How to cite this URL:
Divani G, Gupta S, Ahmed A S. Incidentally detected “tram track forearm arteries” in an elderly. J Clin Prev Cardiol [serial online] 2021 [cited 2022 Jan 19];10:150. Available from: https://www.jcpconline.org/text.asp?2021/10/4/150/333704



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.
Figure 1: CIne flouroscopy showing calcified radial and ulnar artery

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




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