Читать книгу Interventional Cardiology - Группа авторов - Страница 72

Factors influencing success of the radial access route include radial artery diameter; anatomical variations; and operator proficiency and expertise with the radial approach [2,6]. Simple palpation of the radial pulse provides a reasonable feel for selection of sheath size and feasibility of TRA. Sheath: artery ratio is an important determinant of radial spasm, patient discomfort and radial artery occlusion.

There is generous vascularization to the hand by the radial, ulnar and interosseous arteries. This collateralized blood supply provides excellent protection against distal ischemia, which outside of distal embolization from the radial sheath is exceptionally rare [12]. The modified Allen’s and Barbeau tests are still used by some operators to assess the patency of the ipsilateral ulnar circulation. A number of RCTs have demonstrated that in patients undergoing TRA, an abnormal modified Allen's or Barbeau tests does not predict adverse events or increased hand ischemia (either clinical or subclinical). As such, tests of ulnar/collateral patency are not supported in current guidelines for access site selection [3,13].