The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions

Abstract

In an effort to refine transcatheter vascular interventions, radial artery access has moved more distally at the anatomical snuffbox. Here, more challenges appear as the artery is smaller, more angulated, and more difficult to palpate. Including ultrasound guidance as a mandatory step during puncture may encourage more operators to switch to this approach. In the femoral approach, ultrasound guidance is strongly recommended because of bleeding complications, whereas in the proximal (conventional) radial approach, the role of ultrasound remains optional, and in current practice, almost all cases are performed by palpation of the pulse only. However, in distal radial access, the situation is different because the artery differs in caliber and position, and imaging can help the operator for a clean puncture, especially since repeated punctures are not only painful but also any hematoma formation leads to the complete compression of the artery and failure of access. The aim of this review is to investigate the rationale of vascular ultrasound during distal radial access and to establish some techniques and anatomical landmarks for the ultrasonographic exploration of the dorsal area of the hand.

Lower Patient Height and Weight Are Predisposing Factors for Complex Radial Arterial Catheterization

“…A meta-analysis by Gu et al revealed that radial artery catheterization first-attempt failure was significantly reduced by the use of 2D ultrasound, as were hematoma complications and the mean time needed for successful cannulation [ 5 ]. Similar results have been shown for alternative radial access routes such as the distal approach performed at the level of the snuffbox, with ultrasound reducing complications and maximizing technical success, even in small-diameter or pathological arteries [ 6 ]. Moreover, the results of the RAUST trial (Radial Artery Access With Ultrasound Trial) demonstrated the advantages of ultrasound use in radial artery cannulation in a randomized multicenter setting [ 14 ].…”

“…Last, although performed uniformly in all patients by the same experienced operators, arterial cannulation was not strictly standardized but was left to the discretion of the anesthetist taking care of the patient. Since the classical forearm proximal access was used in all cases, our results cannot be transferred to other approaches such as the distal radial artery access performed at the level of the snuffbox, which has recently been proven to be non-inferior compared with the conventional proximal radial access [ 6 , 7 ].…”

“…All catheterizations in both groups (see below) were performed uniformly by the same three operators, all of whom were board-certified anesthesiologists with years of experience in performing arterial and venous vascular punctures. In all cases, punctures were performed at the level of the proximal radial artery, approximately 2 cm proximal to the radial styloid (to be differentiated from the recently described distal radial access, which is performed at the level of the snuffbox [ 6 , 7 ]). All catheterizations performed primarily using ultrasounds were excluded from subsequent analyses.…”

Radial access versus distal radial access: the vote for use of ultrasonography?

“…The novel transradial access site, distal radial access (DRA), has gained popularity owing to improved patient and operator comfort, and faster hemostasis with shorter artery gauze compression. Despite the emerging technique and increasing amount of data in favor of preprocedural ultrasonography (pre-US) including DRA [ 1 ], the choice of the artery is still based on pulse recognition.…”

Vascular Diseases: Etiologic, Diagnostic, Prognostic, and Therapeutic Research

“…In their paper, A. Achim et al [ 14 ] highlight the usefulness of ultrasound in accessing the distal radial artery at the anatomical snuffbox for cardiovascular interventions. Although the role of ultrasound remains optional in the proximal (conventional) radial approach, the authors encourage the use of ultrasound because the artery differs in caliber and position.…”