Distal Radial Artery Access: The Future of Cardiovascular Intervention.

Zaid Nairoukh,Saira Jahangir,Bilal Haider Malik,Dennis Adjepong

doi:10.7759/cureus.7201

Abstract

Access sites for coronary intervention have been changing over the last several decades, from the femoral artery to the radial artery and then to the distal radial artery. Distal radial access, which was first used in 2017 and is still not recommended by the guidelines, shows a higher success rate and less complications than other sites; therefore, it might be the future for cardiovascular intervention. In this study, we reviewed almost all of the articles that are related to the distal radial access, from 2017 to present, and summarized the technique, success rate, advantages, disadvantages, and noncardiac use of this access site.

Highlights

BackgroundOver the last several years, many changes have occurred in the treatment of ischemic heart diseases; one of these changes is the route of arterial access for both coronary angiography and percutaneous coronary interventions.Access changed from transfemoral to transradial approach (TRA), as it has less bleeding complications, decreased hospital mortality rate, less access site complications, and is cost-effective as compared to the transfemoral approach [1]
The use of TRA is not free of limitations; many complications have been associated with the TRA due to small diameter, such as radial artery occlusion (RAO) (The reported incidence of RAO is highly variable in the range of 2%-10%, and a meta-analysis by Rashid showed that the RAO incidence within 24 hours was 7.7%), radial artery spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, bleeding, nerve damage, and complex regional pain syndrome [3,4]
We review the most related and recent articles to know more about the distal transradial approach (dTRA) through rapid revision of radial artery anatomy

Summary

Introduction

Over the last several years, many changes have occurred in the treatment of ischemic heart diseases; one of these changes is the route of arterial access for both coronary angiography and percutaneous coronary interventions. Other advantages include early hemostasis, low risk for hematoma formation, low level of pain perceived by patients, reduced risk of compartment syndrome, saving the radial artery for possible future coronary artery bypass graft, and the ability of the operator to work at a safe distance from the radiation source [5,13,22,31]. It might be a potential site for retrograde recanalization of RAO [32]. The last one, which is common, is using the DRA for arteriovenous fistula in dialysis, which affords more advantages than the traditional proximal fistula [35,36]

Conclusions

Disclosures

Findings

Kiemeneij F