Collateral arterial formation in a severed brachial artery causing difficult transradial access during percutaneous transluminal coronary angioplasty.
In this article, we describe about a 49-year-old patient who underwent percutaneous coronary intervention for a non-Q wave myocardial infarction via a transradial approach. The procedure was technically difficult, and the following fluroscopic image was obtained soon after radial arterial puncture (Figure 1). 



Figure 1. 
Severed brachial artery, and vascular flow maintained via a newly formed laterally positioned highly tortuous collateral artery. It was not possible to advance the catheter through the tortuous collateral vessel.



Further questioning revealed that the patient suffered a fall in 1975 while working …