Distal Transradial “Snuffbox” Approach

2021 ◽  
pp. 23-30
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H. Chen ◽  
Pascal M. Jabbour ◽  
Eric C. Peterson
Keyword(s):  
Radial Artery ◽  
Lower Risk ◽  
Patient Positioning ◽  
Diagnostic Procedures ◽  
Interventional Cardiology ◽  
Neutral Position ◽  
Radial Approach ◽  
Radial Access ◽  
Frequent Use ◽  
Distal Location

The distal radial or “snuffbox” approach is a modification of the traditional radial approach that uses a more distal location of the radial artery for puncture. The radial artery at this location is beyond the palmer arch thus puncturing has a theoretically lower risk of hand or thumb ischemia. In addition, the hand is positioned in the neutral position so it is more comfortable for the patient. Finally, the compression times are shorter so the patient can be discharged earlier after diagnostic procedures. This was originally an interventional cardiology innovation because of the frequent use of left radial access in interventional cardiology, but the approach has benefits for right radial access in neurointervention as well. The patient positioning and technical nuances of the snuffbox approach are reviewed.

The Rationale for Radial Artery Access in Neurointerventional Surgery

2021 ◽  
pp. 1-8
Author(s):  
Samir Sur ◽  
Stephanie H. Chen ◽  
Pascal M. Jabbour ◽  
Eric C. Peterson
Keyword(s):  
Radial Artery ◽  
Collateral Circulation ◽  
Interventional Cardiology ◽  
Transradial Approach ◽  
Radial Approach ◽  
The Core ◽  
Radial Access ◽  
Ischemic Complications ◽  
Basic Concepts ◽  
Arterial Anatomy

Over 20 years of investigation and experience have gone into pioneering the radial approach for cardiac interventions. This has shown the technique to be superior to the traditional transfemoral technique for a variety of reasons. Neurointerventionalists have until recently been unaware of this innovation and are only starting to use it in their practice. Most of the data from the interventional cardiology journey into radial access is unknown to the neurointerventionalist audience, and concepts that underpin radial access are unfamailiar. Even basic concepts such as radial arterial anatomy, collateral circulation of the hand, and low rates of ischemic complications have been siloed in the cardiology literature. The core rationale for the transradial approach is reviewed.

Abstract 17406: Early Experience With Ultrasound Guided Distal Trans-Radial Access in the Anatomical Snuffbox in Coronary Angiography and Intervention

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Sangyeub Lee ◽  
Woong-su Yoon ◽  
Daehwan Bae ◽  
Min Kim ◽  
Sang Min Kim ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Success Rate ◽  
Radial Artery ◽  
Early Experience ◽  
Coronary Intervention ◽  
Ultra Sound ◽  
Potential Candidate ◽  
Ultrasound Guided ◽  
Radial Approach ◽  
Radial Access

Early experience with ultrasound guided distal trans-radial access in the anatomical snuffbox in coronary angiography and intervention. Objective: We aimed to demonstrate the feasibility and safety of the ultrasound guided distal trans-radial coronary angiography and intervention. Methods: Patients assigned to one operator program underwent diagnostic or procedural intervention through distal trans-radial approach in the anatomical snuffbox between January 2018 and May 2018. All of patients had palpable artery in their distal radial artery. The operator did the coronary procedure via distal radial access at anatomical snuffbox. When the pulse was weak or the target artery was very small, the operator punctured under ultrasound guidance (V-scan with dual probe, GE heathcare, USA) Results: 56 patients were enrolled. Mean age of patients was 65.1 years old and 68% were male. About 70% of patients were presented with stable angina feature. In diagnostic procedure, 4F (3, 5.6%) or 5F (29, 54.7%) sheath was used and we did coronary intervention via 6F (21, 39.6%) Sheath. Ultrasound guided puncture was done for 33 patients (58.9%). Overall Success rate of distal trans-radial angiography and intervention was 94.6% (3 failed cases). Success rate of ultrasound guided procedure was 97% (only 1 failed case). Left distal radial puncture was done for 18 patients (33.9%). 16% of patients had chronic kidney disease, especially end stage renal disease (11%) to preserve radial artery which was potential candidate of arteriovenous fistulae for dialysis. There was no BARC type 2-5 bleeding in hospital stay and follow up at out-patient clinic. Conclusion: Ultra sound guided distal radial approach is feasible and safe as a good alternative technique for coronary angiography and interventions.

Left transradial access for cerebral angiography

2019 ◽  
Vol 12 (4) ◽  
pp. 427-430 ◽  
Author(s):  
Guilherme Barros ◽  
David I Bass ◽  
Joshua W Osbun ◽  
Stephanie H Chen ◽  
Marie-Christine Brunet ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Vascular Complications ◽  
Cerebral Aneurysms ◽  
Retrospective Chart Review ◽  
Interventional Cardiology ◽  
Distal Catheter ◽  
Radial Access ◽  
Transradial Access ◽  
Clinical Scenarios

IntroductionTransradial access is increasingly used among neurointerventionalists as an alternative to the transfemoral route. Currently available data, building on the interventional cardiology experience, primarily focus on right radial access. However, there are clinical scenarios when left-sided access may be indicated. The purpose of this study was to evaluate the technical feasibility of left transradial access to cerebral angiography across three institutions.MethodsA retrospective chart review was performed for patients who underwent cerebral angiography accessed via the left radial artery at three institutions between January 2018 and July 2019. The outcome variables studied were successful catheterization, vascular complications, and fluoroscopic time.ResultsNineteen patients underwent a total of 25 cerebral angiograms via left transradial access for cerebral aneurysms (n=15), basilar occlusion (n=1), carotid stenosis (n=1), arteriovenous malformation (n=1), and cervical neurofibroma (n=1). There were 12 diagnostic angiograms and 13 interventional angiograms. The left transradial approach was chosen due to left vertebrobasilar pathology (n=22), right subclavian stenosis (n=2), and previous right arm amputation (n=1). There was one instance of radial artery spasm, which resolved after catheter removal, and one conversion to transfemoral access in an interventional case due to lack of distal catheter support. There were no procedural complications.ConclusionsLeft transradial access in diagnostic and interventional cerebral angiography is a technically feasible, safe, and an effective alternative when indicated, and may be preferable for situations in which pathology locations or anatomic limitations preclude right-sided radial access.

Snuff box radial artery access for arteriovenous fistula intervention

2019 ◽  
Vol 21 (2) ◽  
pp. 237-240
Author(s):  
Jeffrey Hull ◽  
Stephanie Workman ◽  
Jean Isabell Heath
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Ultrasound Guidance ◽  
Neutral Position ◽  
Extensor Pollicis Longus ◽  
Radial Access ◽  
Major Complications ◽  
The Mean ◽  
Steal Syndrome

Purpose: The aim of this article is to retrospectively compare snuff box radial artery access with direct fistula access for radiocephalic fistula intervention. Materials and Methods: Review of 68 consecutive radiocephalic interventions between April 2013 and April 2017 was performed. The snuff box radial access was performed under ultrasound guidance with the hand in a neutral position (thumb up). The snuff box radial artery was entered distal to the extensor pollicis longus, over the trapezium bone. Hand held pressure was applied for hemostasis. The procedure times, success, and complications of snuff box radial artery access procedures were reviewed. Results: Snuff box radial artery access was used in 25% (17/68) of radiocephalic fistula interventions. All access procedures were successful. Snuff box radial artery access was only used in cases involving the proximal fistula. Lesions treated from snuff box radial artery access approach included 19% (10/54) of fistula stenosis, 50% (1/2) thrombosis, 63% (5/8) immature fistulae, 100% (1/1) steal syndrome, and none of the (0/5) symptomatic outflow occlusions. The mean procedure times for snuff box radial artery access and direct fistula access were not significant at 29.1 ± 16.3 min (range = 10–81) and 26.8 ± 14.0 min (range = 5–70), respectively (p < 0.57). Minor hematoma occurred in 12% (2/17) snuff box radial artery access and 2% (1/51) direct fistula access. There were no major complications. Conclusion: Snuff box radial access was used successfully for radiocephalic fistula intervention with procedure times similar to direct fistula access without major complications.

Transradial intraoperative cerebral angiography: a multicenter case series and technical report

2019 ◽  
Vol 12 (2) ◽  
pp. 170-175
Author(s):  
Joshua W Osbun ◽  
Bhuvic Patel ◽  
Michael R Levitt ◽  
Alexander T Yahanda ◽  
Amar Shah ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Carotid Arteries ◽  
Case Series ◽  
Patient Positioning ◽  
Interventional Cardiology ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Access Site Complication

BackgroundUse of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.ObjectiveTo report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.Methods27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.Results24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.ConclusionsTransradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.

scholarly journals Distal radial approach for neurointerventional diagnosis and therapy

2019 ◽  
Vol 10 ◽  
pp. 211 ◽  
Author(s):  
Javier Goland ◽  
Luis Domitrovic ◽  
Gustavo Doroszuk ◽  
Silvia Garbugino ◽  
Paula Ypa
Keyword(s):  
Radial Artery ◽  
Hospital Costs ◽  
Diagnostic Procedures ◽  
Initial Experience ◽  
Puncture Site ◽  
Transradial Approach ◽  
Radial Approach ◽  
Diagnosis And Therapy ◽  
First Choice ◽  
Therapeutic Procedures

Background: The transradial approach results in fewer complications at the puncture site, lower hospital costs, and greater comfort for patients. The distal transradial approach (dTRA) adds some benefits over the conventional radial approach. The objective is to describe initial experience with distal radial approach technique and the results obtained for neuroendovascular diagnostic and therapeutic procedures. Methods: Description of distal radial approach technique and obtained data from the first 3 months experience using this approach as the first choice for neuroendovascular procedures in two neuroendovascular centers. Results: Of the total of 94 procedures performed during 3 months, 67 were diagnostic and 27 were therapeutic. Eleven (16%) of the diagnostic procedures were performed through the dTRA. Of the 27 embolizations, eight (30%) were done using this approach. Every distal radial approach that was performed for diagnosis and therapeutics was successful. Conclusion: Puncture of the radial artery within the anatomical snuffbox is a radial approach variation option for diagnostic and therapeutic neuroendovascular procedures.

scholarly journals Radial Artery Access

2020 ◽  
Author(s):  
Carmelo Panetta ◽  
Johnny Chahine
Keyword(s):  
Clinical Research ◽  
Radiation Exposure ◽  
Radial Artery ◽  
Ulnar Artery ◽  
The Elderly ◽  
Artery Occlusion ◽  
New Techniques ◽  
Radial Approach ◽  
Radial Access ◽  
Radial Artery Occlusion

Radial artery access for angiography has matured over the past two decades and is now the preferred point of access for most patients. Lower bleeding rates in clinical randomized trials have translated into lower mortality prompting change in the guidelines. Advances in technique with use of ultrasound for access to properly size the sheath, proper dosing of anticoagulation and new techniques for sheath removal have dramatically lowered radial artery occlusion rates. Radial artery spasm has improved with vasodilators and proper sedation. Advances in support boards and sheath extension have opened up left radial access. Advances in lower profile sheaths and sheathless systems allow larger catheters in smaller arteries. Advances in longer balloons and sheaths have opened up radial access for peripheral interventions. Areas of clinical research include use of ulnar artery compared to radial, left versus right radial access, use of radial artery for a surgical conduit after angiography, radiation exposure and advantage of radial approach in the elderly.

scholarly journals Evaluation of radial artery occlusion in patients undergoing diagnostic and therapeutic coronary procedures via distal radial access. A retrospective observational study (RDISTAL DOR)

2021 ◽  
Vol 29 ◽  
pp. 1-7
Author(s):  
Marden Tebet ◽  
Mickael Ogama ◽  
Sergio Kreimer ◽  
Eduardo Santos ◽  
Pedro Andrade ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Radial Artery ◽  
Diagnostic Procedures ◽  
Artery Occlusion ◽  
Vascular Complication ◽  
Medical Community ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Coronary Procedures ◽  
Radial Artery Occlusion

Background: The use of the distal radial access for invasive coronary procedures has been rapidly adopted by the medical community, but with no evaluation of efficacy and safety outcomes of this approach. The objective was to evaluate the rate of radial artery occlusion involved in this technique, using Doppler ultrasound. Methods: This was an observational, retrospective study involving patients undergoing invasive diagnostic or therapeutic coronary procedures via distal radial access, with assessment of the radial artery patency by Doppler ultrasound. The primary outcome analyzed was the rate of radial artery occlusion. Results: Between July and December 2020, 51 patients underwent procedures via distal radial access, with assessment of the radial artery patency, out of a total of 603 patients seen during this period. Patients were aged 58±10.8 years, 68.6% were male, 26.9% had diabetes mellitus, and 68.6% were diagnosed with acute coronary syndrome. Diagnostic procedures were performed in 68.2% of sample, and 23.5% of patients had undergone a previous use of the ipsilateral proximal radial access. Doppler ultrasound was performed over a mean period of 24 hours, and no occlusion of the radial artery was observed, with mean time for sheath insertion of 1.9 minutes. There was no major vascular complication. In two patients, pain was observed at the access point; another two had a small subcutaneous hematoma, and, one patient, presented with moderate spasm. Conclusion: The use of distal radial access was associated with a low rate of hemorrhagic complications in the access route, and absence of occlusion of the radial artery by Doppler ultrasound assessment.

P4597Impact of operator experience with radial approach for clinical outcome on percutaneous coronary intervention in acute coronary syndrome performed with femoral artery access site

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Tokarek ◽  
A Dziewierz ◽  
K Plens ◽  
T Rakowski ◽  
M Zabojszcz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Radial Artery ◽  
Femoral Artery ◽  
Coronary Intervention ◽  
Access Site ◽  
Radial Approach ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Percutaneous Coronary

Abstract Introduction Radial approach (RA) for percutaneous coronary intervention (PCI) is associated with reduced mortality and access site complications. The routine use of the RA in patients should be strongly considered, keeping in mind the learning curve associated with the technique. However, promotion of RA may interfere with the equally important goal of maintaining proficiency in the femoral approach (FA), which is essential in a variety of procedures as well as when RA fails. There is possible risk of higher rate of complications in PCI with FA performed by operators mainly using radial artery as access site. Purpose The aim of this study was to evaluate impact of experience and proficiency with RA for clinical outcomes on PCI via FA in “real-world” patients with acute coronary syndrome (ACS). Methods A total of 539 invasive cardiologists performing PCI in 151 invasive cardiology centers on the Polish territory between 2014 and 2017 were included in study analysis. Proficiency threshold has been set at >400 procedures during four consecutive years per individual operator. They were categorized to quartiles according to total volume of radial artery utilization during all PCIs. Procedures performed on patients with Killip-Kimball class IV on admission to catheterisation laboratory were excluded from analysis. Results The most of the operators performed >75% of all procedures via radial artery (326 (60.5%)), 112 (20.8%) used RA in 50–75% of cases, 67 (12.4%) in 25–50% of all PCIs and only 34 (6.3%) invasive cardiologist were using RA in less than 25% of all procedures. Mortality during PCI via FA was higher in group of invasive cardiologist with >75% of all procedures performed with radial access (>75% vs. 50–75% vs. 25–50% vs. <25%: 1.63% (±2.52%) vs. 0.93% (±1.05%) vs. 0.68% (±0.73%) vs. 0.31% (±0.40%); p=0.01). A trend towards higher rate of bleeding at the puncture site during PCI procedures with femoral artery were reported in groups of operators with higher expertise in RA (>75% vs. 50–75% vs. 25–50% vs. <25%: 0.43% (±1.09%) vs. 0.14% (±0.36%) vs. 0.21% (±0.45%) vs. 0.14% (±0.37%); p=0.09). Conclusions Higher experience in radial access might be linked to worse outcome in PCI via FA in ACS settings. Femoral artery is important vascular approach and should not be abandoned while learning procedures with radial artery utilization. Acknowledgement/Funding None

scholarly journals Hospital results of endovascular treatment of patients with Acute Coronary Syndrome (ACS) through distal radial access

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.G Koledinskiy ◽  
Y.U.V Mikheeva ◽  
P.P Ogurtsov ◽  
D.S Kurtasov ◽  
N.L Vyazova
Keyword(s):  
Radial Artery ◽  
Final Conclusion ◽  
Cardiac Events ◽  
Femoral Access ◽  
Exact Test ◽  
Radial Approach ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Adverse Cardiac Events ◽  
Angiographic Data

Abstract Background Radial access is traditionally the first line method for percutaneous coronary interventions (PCI). However, it has its drawbacks. Recently a new distal radial approach (DRA) has been proposed. The results of using this method in patients with ACS are not defined. Aim of this study To evaluate the safety, efficacy and hospital outcomes ot treatment of patients with ACS using DRA during PCI as compared to traditional radial access (TRA). Materials and methods A single-center randomized trial included 264 people who underwent PCI in the period from November 2018 to May 2019 at our clinic. The proportion of patients with unstable angina was 60.6% (n=160), with acute myocardial infarction 39.4% (n=104). Patients were divided into 2 groups: in the 1st gr. (n=132) was used DRA, in the control 2nd gr. (n=132) - TRA. The studied groups were comparable according to the initial clinical and angiographic data. All interventions were performed by experienced endovascular cardiologists who perform more than 300 PCI per year. Statistical methods We used a program Statistica 6.0, v. 15, Pearson's criterion, Fisher's exact test, t-test. Results During PCI, 228 drug-coated stents were implanted in 104 patients. 10 patients had access conversion during PCI: from DRA to TRA in 3 patients, to femoral access - in 4 (the total number of conversions from DRA was 5.3%), from transradial to femoral in 3 people (2.3%), and therefore in the 1st group left 125 patients for observation, in the second - 129, respectively. The average puncture time was 125.1±11.9 sec. in the 1 gr. and 58.8±8.2 sec. in the 2 gr. (p≤0.00005). There was no difference in the total execution time of PCI: 30.5±7.1 min. in the 1 gr. and 29.4±4.6 min. in the 2 gr. (p≥0.1428). The duration of hemostasis was significantly higher in the TRA group: 354.2±28.1 min. against 125.4±15.3 min. in the 1 gr. (p≤0.00005). In the DRA group, there was a lower incidence of hematomas: in 1 patient (0.8%) versus 9 (7.0%) in the TRA group (p=0.019), radial artery spasm: in 7 patients (5.6%) versus 17 (13.2%) in the 2 gr. (p=0.039) and thrombosis at the access site: occlusion radial artery was observed only in 1 patient (0.8%) in the DRA group, while in the TRA group - in 8 (6.2%), p=0.036. The frequency of Major Adverse Cardiac Events (MACE) in the studied groups at the hospital stage was similar: 2.4% of cases (n=3) in the 1st gr. and 2.3% (n=3) in the 2nd group (p=1.0). Conclusions Our one-center prospective study showed: The use of distal radial access does not extend the overall procedure time compared to transradial approach. The frequency of major complications is comparable in the two studied groups. We noted a significantly lower frequency of local complications when using DRA compared to TRA. So, distal radial approach may be an alternative to transradial access, however, large randomized trials are needed for a final conclusion. Funding Acknowledgement Type of funding source: None

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