Safety and Feasibility of Ultrasound-Guided Access for Coronary Interventions through Distal Left Radial Route

Abstract

Aims. Left distal transradial arterial approach (ldTRA) is a new interventional route that spares right radial artery (RRA) for use in haemodialysis and as bypass graft. Vasant Kunj Left dIstal Transradial ArtEry approach (VKLITE) study aimed to assess the feasibility and safety of ldTRA access during coronary angiography (CAG) and percutaneous coronary intervention (PCI). Methods and Results. Between April 2018 and June 2020, 108 patients were enrolled and underwent CAG ± PCI via ultrasound guided ldTRA. Arterial puncture, CAG, and PCI were successful in 96.3% (104/108), 92.1% (93/101), and 94.1% (32/34) patients, respectively. Access site crossover rate was 14/108 (13.0%). Mean puncture, procedure, and haemostasis time (minutes) were 6.7 ± 7.1, 55.7 ± 32.8, and 23.1 ± 11.9. Median total fluoroscopic time was 6.6 minutes (IQR-14.2), and median total radiation dose was 39.2 Gy-cm2 (IQR-97.0). Local haematoma occurred in 11 patients (10.2%) with major haematoma in 1.9%, all recovering within three weeks. Mean pain score was 2.4 ± 2.3, and patient satisfaction score was 9.0 ± 1.3. LdTRA access compared with RRA access (n = 121) showed significantly increased mean procedure time (55.7 ± 32.8 vs. 43.9 ± 26.0 minutes, p = 0.01) and median total fluoroscopic time (6.6 [IQR-14.2] vs. 4.7 [IQR-8.2] minutes, p = 0.02), with similar median total radiation dose (39.2 [IQR-97.0] vs. 43.8 [IQR-54.5] Gy-cm2, p = 0.56). No radial artery loss, dissection, pseudoaneurysm, arteriovenous fistula, or nerve injury was noted. Conclusions. LdTRA access is feasible with few complications during CAG/PCI. Patient comfort and satisfaction makes it a desirable route for coronary interventions.

The distal radial artery: Versatile vascular access for transcatheter interventions

“…While the use of ultrasound is standard of care for many transvascular interventions, its use in DRA remains at the discretion of the operator and the center's expertise, although there are signals for a higher patient satisfaction and success rate (multiple through-and-through attempts and inadvertent needle injury of underlying periosteum causes severe pain and predisposes to arterial spasm). 27 The same RATATOUILLE study used ultrasound-guided DRA for approximatively 85% of participants which highlights the effectiveness of US use in both DRA and TRA. 24 In relation to hemostasis, DRA showed significantly shorter times.…”

Application of ultrasound in cardiovascular intervention via the distal radial artery approach: New wine in old bottles?

“…A total of 3,581 articles were initially retrieved. Based on the titles and abstracts and removing duplicate articles, a total of 22 studies were ultimately enrolled (2,6,12,13,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), with thirteen studies from Asia, five from Europe, two from North America, and two from South America. The sample sizes ranged from 42 to 2,775 cases.…”

“…The results of a meta-analysis showed that the size of the outer diameter of the vascular sheath was positively correlated with the incidence of RAO (41), and mismatch between the sheath and vessel diameter increased the incidence of RAO. To reduce the risk of vascular injury, an increasing number of studies have focused on the preoperative assessment of the DRA diameter (2,6,12,13,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Selection of suitable sheaths according to the diameter of the DRA appeared to reduce vascular damage (24).…”

“…This visualization of the puncture not only increases the success rate but also reduces the complications, especially for precise or emergency interventions. In recent years, an increasing number of studies have explored the relationship between ultrasound guidance and puncture success rate (11)(12)(13). Although in a small sample retrospective cohort study, the puncture success rate was similar between ultrasound-guided and palpation methods (49).…”

“…Compared with the conventional radial artery (CRA) approach, the distal transradial approach (dTRA) dramatically reduces the risk of bleeding and radial artery occlusion (RAO) and offers higher operator and patient comfort (2)(3)(4)(5). Although there is no discernible difference between the two techniques in terms of puncture success rate and other characteristics (6), there is a noticeable learning curve for dTRA puncture, with a longer puncture time than the transradial performed via the dTRA, which can not only improve the success of puncture and catheterization (11)(12)(13) and shorten the time of dTRA puncture and catheterization (14) but also monitor vascular access-related problems. In light of the contemporary literature, we systematically evaluated the value of ultrasound in the perioperative period of cardiovascular interventions performed via the dTRA.…”