J Transcat Intervent.2021;29:eA202102.

EDITORIAL

Distal transradial access to prevent proximal radial artery occlusion: what is really known?

Marcos Danillo Peixoto Oliveira , Adriano Caixeta

DOI: 10.31160/JOTCI202129A202102

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Transradial access (TRA) offers important advantages over transfemoral approachs, including early patient ambulation, improved patient comfort, less vascular complications, lower health care costs, and reduced adverse cardiovascular events, including mortality. Nevertheless, complications of TRA still exist, and radial artery occlusion (RAO) occurred in up to 30% of cases, in a prospective vascular ultrasound study. Due to dual blood supply to the hand, RAO is usually asymptomatic and unnoticeable, although sometimes it may be associated with distal ischemia, paresthesia, pain at the site of occlusion, and loss of hand function. Most importantly, RAO may prevent future use of the radial artery (RA) for hemodialysis fistula creation, surgical coronary artery bypass grafting, reconstructive surgery, and repeat TRA procedures.

Distal TRA (dTRA) has recently gained large popularity worldwide. As a refinement of the standard proximal TRA (pTRA), this relatively new technique may have additional advantages, in terms of patient’s and operator’s comfort, faster haemostasis, and risk of proximal RAO (pRAO). Importantly, in cases of RAO, since arterial puncture with dTRA is performed after the point of emergence of the superficial palmar branch of the RA, blood flow through the palmar arch would not be compromised and, therefore, the risk of ischemic injury would be minimum.

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