Anatomical snuff box approach for percutaneous coronary interventions – Current status

Abstract

Anatomical snuff box or distal radial artery approach for various percutaneous coronary angiograms and interventions has gained increased interest in recent years. The main advantage is the ergonomic comfort to the patient as it allows the patient's arm to be in more natural position. The safety and feasibility of this novel approach has been studied in past few years but still the data is limited and the distal radial artery approach has not been included in the guidelines. The present review focuses on the latest evidence, technique, advantages and disadvantages of this distal radial artery access.

Ultrasound‐guided distal transradial access for cardiac catheterization: Technical notes for the interventionalist

“…To optimize the vessel view, adequate heel‐toe and toggle probe's movement must be performed by the operator. Then, using either a short‐ or long‐axis view, the puncture can be performed under US‐guidance using either 20 or 21 G needle as in routine radial artery cannulation 13 with a 30° angle from the ulnar to the radial plane. The puncture site should be along the course of distal radial artery in the area between the extensor pollicis brevis and longus.…”

“…Therefore, for the cannulation of the dRA, another method able to differentiate arteries from veins is represented using color and spectral Doppler; the veins will have a phasic flow whereas arterial flow will be pulsatile (Figure 4). either a short-or long-axis view, the puncture can be performed under US-guidance using either 20 or 21 G needle as in routine radial artery cannulation 13 with a 30°angle from the ulnar to the radial plane. The puncture site should be along the course of distal radial artery in the area between the extensor pollicis brevis and longus.…”

Insights with consensus on Abductor Pollicis Longus from the Central Indian population at Nagpur, Maharashtra

“…In coronary angiographic investigation or percutaneous intervention, an anatomical snuff box is approached to identify the distal part of the radial artery. [ 2 ] The roof bears the origin of the cephalic vein from the dorsal venous arch of the hand, accompanied by a superficial branch of the radial nerve. Noteworthy to mention about lateral most tendon, one of the 'outcropping muscles' i. e. Abductor pollicis longus arises from the posterior aspect of the ulna, adjoining interosseous membrane and the middle third of the dorsal aspect of the radius.…”

Special Issue “Coronary Artery Disease Interventions”

“…As the most common source of periprocedural complications, emphasis has been placed on achieving fundamental improvement, through which radial access has become the default option due to its superiority to femoral access [2,3]. However, further refinement of the technique is inevitable, resulting in the implementation of novel techniques such as distal radial access (dRA), which has gained importance as demonstrated by the growing number of studies that describe several of its advantages [4]. Achim et al stated the excellent feasibility, safety, and fast learning curve of dRA in their multicenter trial [5].…”