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Abstract
Background and Aim Over the last few years, there has been a drive towards using distal trans-radial (dTRA) access for coronary angiography and interventional procedures. The suggested benefits are better radial arterial patency post-procedure, relatively rapid haemostasis and improved ergonomics for left radial access. The findings from observational studies are promising and a large multicenter randomized trial is now underway. However, so far there is no published data from any centers in the UK about its use and safety. Due to the various potential benefits, this approach was used in our institute which is a busy District General Hospital in the UK providing tertiary cardiology service to a population of 750,000. Data was collected prospectively for the initial 100 cases to assess feasibility and immediate safety of dTRA.
Methods Patients included were from acute and elective cases under the care of 2 consultants where a strong distal radial pulse was palpable. Operators included 2 consultants, 1 senior interventional fellow and 2 Specialty registrars. Arterial puncture was performed using seldinger technique by manual palpation; use of ultrasound was optional. 6 Fr radial glide sheath was used for all cases. Haemostasis was achieved either by a modified conventional TR band or dedicated TR band for dTRA. A proforma was designed to capture relevant data prospectively. Results are presented in percentage.
Results Table 1 shows the important baseline characteristics and findings of this study. Puncture for dTRA was successful in 96% cases. In 2 cases, there was cross-over to contralateral dTRA due to severe spasm and radial artery tortuosity. In 4 cases, dTRA access was unsuccessful either due to failed puncture or inability to advance the guidewire and operator crossed-over to conventional radial route (Figure 1). Radial spasm was experienced by 7 patients in total. There were no immediate major complications. 3 patients developed small haematoma due to displacement of the modified conventional TR band which resolved by manual compression. This issue did not recur after using dedicated dTRA TR bands.
Conclusions This small study demonstrates that the dTRA route might be a safe and effective alternative to the conventional radial route with high success rate without any immediate major complications. The extent of spasm and small haematoma noted in this study is not different from using conventional approach. The current literature suggests several potential benefits of this access route but data from large randomised trials are required to assess long term safety and efficacy to decide whether this should become the preferred option or to be used in selected cases such as for left radial access and in patient who might require a fistula for dialysis.
Conflict of Interest None