Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI)

Abstract

Aims: The aim of this technical report is to demonstrate the feasibility of the left distal transradial approach for patients in whom left radial access is preferred over right radial access for coronary angiography and interventions. This procedure is more convenient for the operator. For the right-handed patient, the left radial access is more convenient because of the free use of the right hand after the procedure. In addition, this technique reduces the chance of radial artery occlusion at the site of the distal forearm.

Methods and results: Coronary access via the left distal radial artery at the anatomical snuffbox allows comfortable positioning of the dorsal side of the patient's left hand near the right groin. The operator can puncture the artery and perform the coronary cannulation at a safe distance from the radiation source and without the need to bend over the patient. This technique will be described in detail. Procedural and clinical results in the first 70 patients are described. Out of 118 consecutive patients assigned to the author's operation programme, 70 patients were considered suitable for left distal radial access. There were eight procedural failures, requiring crossover to traditional right radial or left radial approach. All other procedures were successful, without major discomfort for the patient and operator. No radial artery occlusions at the site of the forearm were encountered.

Conclusions: Left distal transradial coronary access via the anatomical snuffbox, as default technique for patients who need or prefer left radial access over right radial access, deserves further exploration.