TITLE:
Initial Experience on Anatomical Snuff Box Approach for Coronary Angiogram & Percutaneous Coronary Intervention in a Tertiary Care Center Nepal
AUTHORS:
Ratna Mani Gajurel, Ravi Sahi, Hemant Shrestha, Sanjeev Thapa, Rajaram Khanal
KEYWORDS:
CAD: Coronary Artery Disease, CAG: Coronary Angiogram, PCI: Percutaneous Coronary Intervention, Radial Artery: RA
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.8 No.12,
December
28,
2018
ABSTRACT: Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: 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 comparing to the traditional technique.