J Transcat Intervent. 14/Jun/2018;26:a0002.
Initial experience with left distal transradial access for invasive coronary procedures
The recently described distal puncture of the left radial artery through the anatomical snuffbox (radial fossa) can be considered a refinement of the original technique. Its potential benefit is greater comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our goal was to evaluate the safety and feasibility of this new approach.
A prospective registry of patients who underwent invasive diagnostic or therapeutic coronary procedures through the left distal radial artery. The primary endpoints were the access crossover rate and in-hospital access-site related complications.
Between September 2017 and January 2018, 70 patients were screened, of which 61 (87%) were selected. In 4.9% of cases, left distal radial access cannulation was unsuccessful. The mean age was 62.2±11.6 years, 67.2% were male and 37.9% diabetic. Diagnostic procedures were performed in 79.3% of sample, using 5-French sheaths in 67.2% of cases. The duration of the procedure was 24.8±15.2 minutes and fluoroscopy time was 9.6±11.3 minutes. There was one (1.7%) case of access crossover, and no major vascular complications. In one patient, mild ecchymosis was observed, with concomitant asymptomatic distal artery occlusion.
Left distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when compared to the traditional technique.