Proximal and distal radial artery approaches for endovascular percutaneous procedures: anatomical suitability by ultrasound evaluation

Meo, Diego; Falsaperla, Daniele; Modica, A; Calcagno, Maria Carla; Libra, Federica; Desiderio, Carla; Palmucci, Stefano; Foti, Pietro Valerio; Musumeci, Andrea; Basile, Antonio

doi:10.1007/s11547-020-01299-4

Cited by 17 publications

(21 citation statements)

References 6 publications

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“…Preoperative radial artery examination of the puncture site is helpful and necessary to determine the vascular condition (whether there is tortuosity or occlusion) in the radial artery and improve the success rate of the puncture process. The average RAD of the TRI group was greater than that of the dTRI group, which is similar to Meo D's conclusion and consistent with the anatomical structure [21]. The overall cannulation success rate in the dTRI group was lower than that in the TRI group, and the dTRI group had more puncture attempts and lower onetime successful cannulation rates, which were consistent with the results of Coomes EA's study [22].…”

Section: Discussionsupporting

confidence: 88%

The technical features of the diagnosis or treatment of coronary artery disease through the distal radial artery approach at the anatomical snuffbox compared with the conventional radial artery approach

Niu²,

Chen³

et al. 2022

J Cardiothorac Surg

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Background To compare the surgical effects of coronary intervention through the transradial intervention (TRI) versus distal transradial intervention (dTRI) approach. Methods From September 2020 to April 2021, 302 patients undergoing coronary artery angiography (CAG) or percutaneous coronary intervention in our hospital were retrospectively included. Patients were divided into the TRI group and dTRI group with 151 cases in each group. The technique features, lesion features, and cannulation process were compared between the two groups. Results The number of patients who underwent CAG in the dTRI group (35.1%) was significantly greater compared with the TRI group (12.6%) (P < 0.01). The rates of triple vessel lesions, calcification lesions and chronic total occlusion lesions were increased in the TRI group compared with the dTRI group (P < 0.05). The average radial artery diameter (RAD) in the TRI group (2.550 ± 0.417 mm) was greater than that in the dTRI group (2.070 ± 0.360 mm) (P < 0.05). The hemostasis time of the dTRI group (173.272 ± 41.807 min) was lower than that of the TRI group (273.417 ± 42.098 min) (P < 0.05). The radial artery occlusion (RAO) rates in the dTRI group (2.6%) were lower than those in the TRI group (8.6%) (P < 0.05). The dTRI group had a higher satisfaction score than the TRI group (P > 0.05). RAD at the puncture site was a predictor of the overall cannulation success rate with an AUC of 0.747 (95% CI 0.663–0.860; P < 0.05). Conclusions Despite a steep learning curve, the dTRI approach had a shorter hemostasis time, reduced RAO rates, and notable preliminary safety results compared with the TRI approach. The dTRI approach can be used as a supplemental method to the TRI approach.

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Section: Discussionsupporting

confidence: 88%

The technical features of the diagnosis or treatment of coronary artery disease through the distal radial artery approach at the anatomical snuffbox compared with the conventional radial artery approach

Niu²,

Chen³

et al. 2022

J Cardiothorac Surg

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“…Since these first experiences, the dTRA appeared feasible and, after a certain learning curve, safe and effective as well. 20 The most important anatomical substrate for a successful dTRA appeared to be the size of the vessel: Meo et al 21 recently demonstrates, using ultrasound in 700 patients, that the average proximal diameter of radial artery is 2.58 mm while the caliber of the distal radial artery was 19.5% lower than the proximal one, with an average diameter of 1.99 mm. Considering a diameter ⩾of 2 mm as a cut-off value or a vessel/sheath ratio >1, they found that 88% of patients have an estimated radial artery caliber suitable for pTRA and that males and patients with BMI > 30 showed a higher mean pRA and dRA being potentially ideal candidates for such type of radial access.…”

Section: Discussionmentioning

confidence: 99%

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

et al. 2021

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Background: A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated. Objective: To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis. Data sources: Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively. Study eligibility criteria: Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years. Study appraisal and synthesis methods: Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, p < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31–069, p = 0.002, I2 = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37–1.13, p = 0.12, I2 = 0% and RR: 0.88, 95% CI: 0.48–1.63, p = 0.001, I2 = 0%, respectively). Limitations: Only eight case-control studies met inclusion criteria Conclusion: This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.

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“…In a large registry of over 1,000 patients, the mean diameter in the distal segment was of 2.3 ± 0.5 mm, while the outer diameter of the 7-French Glidesheath is 2.79 mm, and that of the 6-F is 2.46 mm ( 2 ). Another study found even smaller diameters (2.01 ± 0.53 mm, 19% smaller than the proximal segment) ( 25 ). Nonetheless, none of our patients required crossover due to severe arterial spasm and only one patient developed distal RAO (1.25%).…”

Section: Discussionmentioning

confidence: 98%

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

Achim

Szigethy

Olajos

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDistal radial access (DRA) was recently introduced in the hopes of improving patient comfort by allowing the hand to rest in a more ergonomic position throughout percutaneous coronary interventions (PCI), and potentially to further reduce the rate of complications (mainly radial artery occlusion, [RAO]). Its safety and feasibility in chronic total occlusion (CTO) PCI have not been thoroughly explored, although the role of DRA could be even more valuable in these procedures.MethodsFrom 2016 to 2021, all patients who underwent CTO PCI in 3 Hungarian centers were included, divided into 2 groups: one receiving proximal radial access (PRA) and another DRA. The primary endpoints were the procedural and clinical success and vascular access-related complications. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and procedural characteristics (volume of contrast, fluoroscopy time, radiation dose, procedure time, hospitalization time).ResultsA total of 337 consecutive patients (mean age 64.6 ± 9.92 years, 72.4% male) were enrolled (PRA = 257, DRA = 80). When compared with DRA, the PRA group had a higher prevalence of smoking (53.8% vs. 25.7%, SMD = 0.643), family history of cardiovascular disease (35.0% vs. 15.2%, SMD = 0.553), and dyslipidemia (95.0% vs. 72.8%, SMD = 0.500). The complexity of the CTOs was slightly higher in the DRA group, with higher degrees of calcification and tortuosity (both SMD >0.250), more bifurcation lesions (45.0% vs. 13.2%, SMD = 0.938), more blunt entries (67.5% vs. 47.1%, SMD = 0.409). Contrast volumes (median 120 ml vs. 146 ml, p = 0.045) and dose area product (median 928 mGy×cm2 vs. 1,300 mGy×cm2, p < 0.001) were lower in the DRA group. Numerically, local vascular complications were more common in the PRA group, although these did not meet statistical significance (RAO: 2.72% vs. 1.25%, p = 0.450; large hematoma: 0.72% vs. 0%, p = 1.000). Hospitalization duration was similar (2.5 vs. 3.0 days, p = 0.4). The procedural and clinical success rates were comparable through DRA vs. PRA (p = 0.6), moreover, the 12-months rate of MACCE was similar across the 2 groups (9.09% vs. 18.2%, p = 0.35).ConclusionUsing DRA for complex CTO interventions is safe, feasible, lowers radiation dose and makes dual radial access more achievable. At the same time, there was no signal of increased risk of periprocedural or long-term adverse outcomes.

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Proximal and distal radial artery approaches for endovascular percutaneous procedures: anatomical suitability by ultrasound evaluation

Cited by 17 publications

References 6 publications

The technical features of the diagnosis or treatment of coronary artery disease through the distal radial artery approach at the anatomical snuffbox compared with the conventional radial artery approach

The technical features of the diagnosis or treatment of coronary artery disease through the distal radial artery approach at the anatomical snuffbox compared with the conventional radial artery approach

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

Switching From Proximal to Distal Radial Artery Access for Coronary Chronic Total Occlusion Recanalization

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