Читать книгу Interventional Cardiology - Группа авторов - Страница 75

Recent iterations to TRA technique have seen a large increase in distal radial artery access – as the distal radial runs in the anatomical snuffbox on the dorsum of the hand. This has potential advantages to both patient and operator. A number of studies have demonstrated distal radial access as a feasible and safe alternative to traditional radial access for both coronary angiography and PCI [16,19] with a success rate of 88–100% [20]. Ferdinand Kiemeneij was a pioneer of TRA for coronary interventions in the early 1990s and recently presented his cohort of patients undergoing coronary procedures from the left distal radial artery[16]. For most patients, it is preferable to retain their dominant right hand immediately following the procedure. Given the distal puncture site, any arterial occlusion spares antegrade flow through the superficial palmar branch thereby reducing risk of proximal RAO. Additionally, the distal artery runs in the hand compartment where hemostasis can be achieved with lighter compression immediately over the scaphoid and metacarpal bones.

Potential limitations of the distal radial approach include the slightly smaller caliber of the distal radial artery, which may pre‐dispose to spasm, as well as the close proximity to tendon sheaths and bone that can increase discomfort if punctured. Another important consideration is that distal radial access increases the distance to target vessels by 3–5 cm. As a result, in patients above 6'1", standard length catheters may not reach the coronary circulation. Table 3.1 details common diagnostic and guide catheters with radial specific and traditional catheter types.