Anupam Bhambhani1, Salil Pandey2, Aditi N Nadamani2, Kartikey Tyagi2. 1. Department of Cardiology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India. 2. Department of Radiodiagnosis, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
Abstract
BACKGROUND: Several studies have recently reported regarding feasibility and safety of distal transradial access (d-TRA) in the anatomical snuff-box (ASB); however, literature comparing it with the conventional TRA at the wrist (w-TRA) is sparse. This study compares the technical efficiency and safety of ASB and wrist approaches for TRA for coronary angiography (CAG) and evaluates the radial artery (RA) anatomy at these sites. METHODS: Two hundred consecutive patients undergoing CAG via w-TRA or d-TRA (100 in each group) were investigated. The primary endpoint was comparison of procedural efficiency of the two methods, defined as CAG completion from the intended access site. The secondary endpoints assessed d-TRA approach in terms of achievement of successful cannulation, arterial puncture, access time (AT), and total procedure time (TPT) in comparison with the conventional method. Safety endpoints included radiation parameters and complications. Furthermore, in 112 normal adults, RA anatomy was assessed at wrist and at ASB. RESULTS: In d-TRA group, 77% patients achieved primary endpoint compared with 93% in w-TRA group (p = 0.004). The success of arterial puncture was comparable for d-TRA and w-TRA (93% and 99%, respectively; p = 0.065), but the cannulation rate was lower for d-TRA. Safety endpoints were similar in both the groups. AT and TPT were longer for d-TRA. CONCLUSIONS: The ASB approach for CAG lowers the success rate and prolongs AT and TPT. The RA at ASB is smaller, has a curved course, and more anatomical variations than the RA at the wrist.
BACKGROUND: Several studies have recently reported regarding feasibility and safety of distal transradial access (d-TRA) in the anatomical snuff-box (ASB); however, literature comparing it with the conventional TRA at the wrist (w-TRA) is sparse. This study compares the technical efficiency and safety of ASB and wrist approaches for TRA for coronary angiography (CAG) and evaluates the radial artery (RA) anatomy at these sites. METHODS: Two hundred consecutive patients undergoing CAG via w-TRA or d-TRA (100 in each group) were investigated. The primary endpoint was comparison of procedural efficiency of the two methods, defined as CAG completion from the intended access site. The secondary endpoints assessed d-TRA approach in terms of achievement of successful cannulation, arterial puncture, access time (AT), and total procedure time (TPT) in comparison with the conventional method. Safety endpoints included radiation parameters and complications. Furthermore, in 112 normal adults, RA anatomy was assessed at wrist and at ASB. RESULTS: In d-TRA group, 77% patients achieved primary endpoint compared with 93% in w-TRA group (p = 0.004). The success of arterial puncture was comparable for d-TRA and w-TRA (93% and 99%, respectively; p = 0.065), but the cannulation rate was lower for d-TRA. Safety endpoints were similar in both the groups. AT and TPT were longer for d-TRA. CONCLUSIONS: The ASB approach for CAG lowers the success rate and prolongs AT and TPT. The RA at ASB is smaller, has a curved course, and more anatomical variations than the RA at the wrist.
Authors: Yongcheol Kim; Youngkeun Ahn; Min Chul Kim; Doo Sun Sim; Young Joon Hong; Ju Han Kim; Myung Ho Jeong Journal: Cardiol J Date: 2018 Impact factor: 2.737
Authors: Jose M Cubero; Juan Lombardo; Carmela Pedrosa; Dolores Diaz-Bejarano; Blanca Sanchez; Vicente Fernandez; Coral Gomez; Rafael Vazquez; Francisco J Molano; Luis F Pastor Journal: Catheter Cardiovasc Interv Date: 2009-03-01 Impact factor: 2.692