Calcific Mönckeberg's arteriosclerosis: An uncommon cause of radial access failure

A 53-year-old man with long-standing diabetes, retinopathy and mild renal failure was admitted to our Department for pulmonary oedema and underlying acute coronary syndrome. Left ventricular function was markedly depressed. After medical stabilization, cardiac catheterization was scheduled. Despite successful puncture and optimal back flow, radial artery cannulation with a 5-French dedicated sheath was impossible because of severe vessel calcifications affecting even ulnar arteries. The successful puncture of right common femoral artery was fluoroscopically guided by arterial calcifications. Coronary angiography revealed severe left main and multivessel disease and the patient underwent coronary artery bypass grafting successfully. In Mönckeberg's arteriosclerosis or Medial Calcific Sclerosis, extensive calcium deposits are found in the arterial muscular media. Limb and other medium size muscular arteries are typically affected. Whether Monckeberg's disease exists as a distinct entity is a matter of debate, since it is supposed to be a manifestation of accelerated atherosclerosis in patients with chronic kidney disease. We believe that fluoroscopic evaluation of the upper limbs before attempting radial artery access is a simple step that may add further to the strategies aimed at improving success of transradial cardiac catheterization procedures.