Distal radial artery access in the anatomical snuffbox for coronary angiography and intervention

Abstract

Background: To explore the feasibility and safety of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via the distal radial artery in the anatomical snuffbox. Methods: Ninety two patients who underwent CAG or PCI through distal radial artery access at The Second Affiliated Hospital of Zhejiang Chinese Medical University from September 2017 to March 2018 were included in our study. We collected baseline characteristics, number, and duration of arterial punctures, procedural success rate, postoperative compression time, the numerical rating scale (NRS) scores at 3 hours after procedure, complications, hospitalization duration. Results: The mean age was 69 ± 11years (44–92 years), and there were 57 males (62.0%). The diameter of the right distal radial artery and the more proximal right radial artery were 0.171 ± 0.05 cm, 0.213 ± 0.06 cm, respectively. On average, the number of puncture attempts was 1.52 ± 0.81, access time was 2.3 ± 1.78 minutes (0.33 – 8.72 minutes), access success was 95.7%, the postoperative compression time was 3.41 ± 0.76 hours (2–6 hours), the NRS scores at 3 hours was 1.53 ± 0.72 (1–4), and the mean hospitalization duration was 7.13 ± 4.02 days. Four patients underwent left distal radial artery access and 88 patients underwent right distal radial artery access. There were 3 local hematomas after procedure and 2 patients had vasospasm. There were no cases of major bleeding, arteriovenous fistula, radial artery occlusion, or hand numbness. Conclusion: Cardiac catheterization through the distal radial artery in the snuffbox is safe and feasible. The right distal radial artery access can be routinely carried out.

Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access

“…A position for the patient was described in previous studies ( 11 , 12 ). The left upper arm was placed comfortably on the left side of the patient after the puncture.…”

Distal Transradial Access For Percutaneous Coronary Intervention And Coronary Angiography : Advances In Interventional Cardiology

“…The left hand is placed such a way which is more comfortable for the operator and the patient. 17 After maintaining proper sterility, once the wrist is prepared, access to the artery can be obtained at ease. 10,11 Use of ultrasound may be of beneficial to use for locating the artery, and also may give an idea to the diameter of the vessel and thus help the operator to choose actual size of catheter and sheaths while doing the procedure.…”

“…One need to feed the guide wire gently. 17 Before introduction of the sheath along the guide wire, a small skin incission may be needed to avoid the sheath damage in some cases. After the insertion of the sheath over the short guide wire, the dilator along with the wire may be removed.…”

“…Generally the compression time is shorter than that of conventional radial artery. As the elastic bandage doesn't compress the ulnar artery, 17 the patient's hand pain after operation is less.…”

Acesso radial distal guiado por ultrassonografia para intervenções transarteriais abdominopélvicas

“…Em um estudo envolvendo 92 pacientes submetidos a procedimentos coronarianos por meio do acesso transradial distal onde quatro casos foram à esquerda e 88 à direita, Yu et al 84 obtiveram sucesso técnico em todos os quatro casos de acesso da ARD esquerda, e 84 (95,4%) dos acessos da ARD direita, sendo realizada conversão para acesso transradial convencional nos casos de insucesso. Destes quatro casos de insucesso, um deveu-se a vasoespasmo e três pelo insucesso da punção arterial apesar de mais de cinco tentativas.…”