Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches

Abstract

Since its introduction, the transradial access for percutaneous cardiovascular procedures has been associated with several advantages as compared to transfemoral approach, and has become the default for coronary angiography and intervention. In the last 30 years, a robust amount of evidence on the transradial approach has been mounted, promoting its diffusion worldwide. This article provides a comprehensive review of radial artery access for percutaneous cardiovascular interventions, including the evidence from clinical trials of transradial vs. transfemoral approach, technical considerations, access-site complications and limitations, alternative forearm accesses (e.g., ulnar and distal radial artery), and ultimately the use of the radial approach for structural interventions.

Snuffbox approach for balloon aortic valvuloplasty: A case series

“…After being upgraded to Class I indication in guidelines, radial access has gained more and more popularity, even for structural heart disease transcatheter interventions 8 . This is because the method reduces access‐related complications and requires a shorter recovery and mobilization time.…”

“…We report a review of patients who underwent a BAV procedure with dTRA approach between January 2019 and December 2019. BAV was performed according to international guidelines 8 . All procedures were performed in a single institution (Azienda Ospedaliera‐Universitaria di Ferrara, Italy), and they are included in the Safety and Feasibility of Transradial Mini‐Invasive Balloon Aortic Valvuloplasty registry (SOFTLY‐II NCT03087552).…”

Acesso radial distal guiado por ultrassonografia para intervenções transarteriais abdominopélvicas

“…A artéria radial pode ser dividida em três segmentos: segmento proximal no antebraço, segmento médio já no punho e o segmento distal, na transição do punho e a face dorsal da mão, ao nível da tabaqueira anatômica. Uma rede anastomótica intrínseca formada pelo arco palmar profundo derivado sobretudo da artéria radial e o arco palmar superficial, derivado sobretudo da artéria ulnar, promove um suprimento sanguíneo duplo para a mão 33 .…”

“…Já existem vários trabalhos que evidenciam as vantagens e menores taxas de complicações do acesso transradial para procedimentos intervencionistas coronarianos 33 . O primeiro ensaio randomizado comparando os acessos transradial e transfemoral para procedimentos intervencionistas coronarianos em pacientes com síndrome coronariana aguda foi o RIVAL (RadIal Vs. femorAL access for coronary intervention).…”

“…Outra limitação do acesso transradial convencional inclui pacientes com patologias ortopédicas envolvendo o ombro e o cotovelo, o que pode impedir a rotação do punho para a punção arterial 39 . Além disso, em razão de seu menor calibre, quase 2,5 a 3,5 vezes menor que a artéria femoral, seu uso é restrito em alguns casos onde dispositivos de acesso de maior diâmetro são necessários 33 .…”