Читать книгу Interventional Cardiology - Группа авторов - Страница 74

The feasibility and outcomes of right and left trans‐radial TRA are similar [15], however many operators prefer right TRA due to its compatibility with the traditional cardiac catheterization laboratory layout.

Operators should be familiar with left radial access which is commonly indicated in case of failed right TRA, occluded right radial artery, extreme right radial artery tortuosity, arteria lusoria, arteriovenous shunt in the right arm or plans for a future shunt, past or future use of the right radial artery as a free graft, post bypass grafting with the left internal mammary artery (LIMA) and patient or operator preference [16]. For patients post‐coronary artery bypass grafting (CABG) requiring angiography, left TRA early in the learning curve is associated with increased procedure time, contrast use and operator radiation exposure [17]. Importantly, a recent RCT with experienced radial operators shows left TRA as non‐inferior to a TFA strategy in CABG patients with known anatomy [18].

The left TRA is more convenient for right hand dominant patients, sparing them from temporary post‐procedural reduced use of their dominant hand. For the operator, left radial access can be cumbersome, especially in obese patients. The left arm is required to be in the volar position, however this limits flexion of the forearm to the operator. Furthermore, the operator is exposed to higher radiation doses due to their closer proximity to the radiation source and scatter from the patient’s body [16].