# Transradial Lower Limb Arteriography of the Type Ⅲ Aortic Arch: A Reverse Technique

## TL;DR

A new technique allows lower limb angiography via the radial artery even in patients with a Type III aortic arch.

## Contribution

A novel reverse technique for transradial lower limb arteriography in Type III aortic arch morphology is introduced.

## Key findings

- The reverse technique successfully guided catheters into lower limb arteries via the radial approach.
- No complications were observed in three cases using the reversed Judkins right 4.0 catheter.
- The method involves reversing the catheter at the aortic valve and guiding the wire to the lower limb artery.

## Abstract

Percutaneous coronary intervention is generally performed using the radial artery approach, and in recent years, the radial artery approach has also been used more and more for endovascular treatment. Given this trend, the radial artery approach is also preferable for lower limb angiography when considering patient burden. However, in the case of type III aortic arch morphology, it can be difficult to advance the catheter into the descending aorta using the radial artery approach. In such cases, we have a method for guiding the catheter into the lower limb arteries using the radial artery approach. We were able to perform the procedure without complications in all three cases by reversing the Judkins right 4.0 catheter at the aortic valve, guiding the guidewire to the lower limb artery, and then advancing the catheter to perform lower limb angiography.