Distal radial access for routine consideration in coronary angiography-safety and feasibility study
Keywords:Distal radial, PCI, CAG
Background: Traditionally transfemoral and proximal radial access sites are chosen for percutaneous coronary intervention (PCI) but both these access sites have periprocedural complications with respect to bleeding and radial artery occlusion respectively. Distal radial arterial access has advantages over the two in terms of patient comfort and almost nil periprocedural complications including radial artery occlusion (as the access is distal to the palmar arch) and preservation of proximal radial artery for future procedures like chronic haemodialysis and bypass graft conduit. This study sought to determine the safety, feasibility and advantages of the distal radial artery as routine access site for percutaneous coronary interventions.
Methods: Between March and August 2019 a total of 70 patients were taken up for distal radial intervention (33 only CAG (coronary angiography), 37 adhoc PCI) after obtaining written informed consent before procedure.
Results: Of all the patients undergone CAG and PCI the success rate for puncture and access was 94% with 4 failures with crossover to proximal radial thereof. Periprocedural course remained uneventful and radial pulse palpable well in both distal and proximal course at the time of discharge. Follow-up for further 1 months also showed no access site related complications.
Conclusions: Among patients undergoing PCI distal radial access is definitely a low risk, feasible procedure without any periprocedural complications. It should, therefore be recommended the first-choice access site for all PCI procedures.
Thiele H, Desch S, de Waha S. Acute myocardial infarction in patients with ST-segment elevation myocardial infarction: ESC guidelines 2017. Herz. 2017;42:728-38.
Bertrand OF, Rao SV, Pancholy S. Trans radial approach for coronary angiography and interventions: results of the first international trans radial practice survey. JACC CardiovascInterv. 2010;3:1022-31.
Amoroso G, Kiemeneij F. Trans radial access for primary percutaneous coronary intervention: the next standard of care? Heart. 2010;96:1341-4.
Kiemeneij F. Left distal trans radial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention. 2017;13:851-7.
Cerda A, del Sol M. Anatomical snuffbox and its clinical significance. A Literature Review, Int J Morphol. 2015;33:1355-60.
Roule V, Lemaitre A, Sabatier R. Trans radial versus trans femoral approach for percutaneous coronary intervention in cardiogenic shock: a radial-first centre experience and meta-analysis of published studies. Arch Cardiovasc Dis. 2015;108:563-75.
Sinha SK, Mishra V, Afdaali N. Coronary angiography safety between trans radial and transfemoral access. Cardiol Res Pract. 2016;2016:4013843.
Karrowni W, Vyas A, Giacomino B. Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction patients: a meta-analysis of randomized controlled trials. JACC CardiovascInterv. 2013;6:814-23.
Burzotta F, Trani C, Mazzari MA. Vascular complications and access crossover in 10,676 trans radial percutaneous coronary procedures. Am Heart J. 2012;163:230-8.
Mehta SR, Jolly SS, Cairns J. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST segment elevation. J Am CollCardiol. 2012;60:2490-9.
Mattea V, Salomon C, Menck N. Low rate of access site complications after trans radial coronary catheterization: a prospective ultrasound study. Int J Cardiol Heart Vasc. 2017;14:46-52.
Avdikos G, Karatasakis A, Tsoumeleas A. Radial artery occlusion after trans radial coronary catheterization. CardiovascDiagnTher. 2017;7:305-16.
Davies RE, Gilchrist IC. Back hand approach to radial access: the snuff box approach. Cardiovasc Revasc Med. 2018;19(3):324-6.
Soydan E, Akin M. Coronary angiography using the left distal radial approach - An alternative site to conventional radial coronary angiography. Anatol J Cardiol. 2018.
Valsecchi O, Vassileva A, Cereda AF. Early clinical experience with right and left distal trans radial access in the anatomical snuffbox in 52 consecutive patients. J Invasive Cardiol. 2018;30:218-23.
Hallett S, Ashurst JV. Anatomy, Upper Limb, Hand, Anatomical Snuff Box. StatPearls. Treasure Island (FL). 2018.
Robson AJ, See MS, Ellis H. Applied anatomy of the superficial branch of the radial nerve. ClinAnat. 2008;21:38-45.
Li L, Zeng ZY, Zhong JM. Features and variations of a radial artery approach in southern Chinese populations and their clinical significance in percutaneous coronary intervention. Chin Med J. 2013;126:1046-52.
Tanaka Y, Moriyama N, Ochiai T. Trans radial coronary interventions for complex chronic total occlusions. JACC CardiovascInterv. 2017;10:235-43.