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Background: This study aims to evaluate the feasibility, efficacy, and safety of distal transradial access (dRA) for the endovascular management of malfunctioning dialysis fistulas. This study also compares dRA with conventional access techniques, such as proximal radial and transvenous access, focusing on technical success, clinical outcomes, and vascular access site complications (VASCs). Methods: A retrospective multicenter study was conducted across four hospitals, including 292 patients treated between January 2019 and June 2024. Of these, 57 patients underwent dRA, and 235 received proximal radial or transvenous access. Key outcomes included technical success (successful completion of the procedure), clinical success (restoration of functional dialysis access), and complication rates. Data were collected on procedure times and complication profiles. Results: Technical success was achieved in 96.5% of patients undergoing dRA, compared to 98.3% in those receiving conventional access (p = 0.388). Clinical success was similar between groups (96.5% vs. 97%, p = 0.835). The overall complication rate was 10.5% for dRA and 8.5% for conventional access (p = 0.632). Cannulation time was longer for dRA (109.1 vs. 91.9 s, p < 0.001), but total procedure duration was comparable between the groups. No major complications were observed in either cohort, and improved post-procedure access flow rates were recorded in all patients. Conclusions: Distal transradial access is a feasible and effective approach for the endovascular management of malfunctioning dialysis fistulas, with outcomes comparable to conventional access techniques. It provides a safe alternative, particularly for patients with complex fistulas, while maintaining a low complication profile. [ABSTRACT FROM AUTHOR]

Background The European Society of Cardiology guidelines recommend transradial access (TRA) for coronary angiography due to its advantages, including lower mortality and bleeding complications. Arterial pseudoaneurysms are rare but challenging complications of TRA, occurring in 0.009%–0.05% of procedures. Non-surgical management, especially in cases with large (>1 mm) necks or late discovery, can be difficult due to the limited effectiveness of echo-guided compression and risks of echo-guided thrombin injection, like thrombin embolization leading to necrosis. Case summary An 82-year-old underwent successful non-surgical management of a large-neck pseudoaneurysm following TRA for a primary percutaneous coronary intervention of the left anterior descending artery. Clinical examination revealed a pulsatile mass at the puncture site, diagnosed via ultrasound as a pseudoaneurysm with a >1 mm neck. Through distal radial access, an initial 5 Fr sheath was upsized to 8 Fr based on ultrasound findings, achieving complete pseudoaneurysm exclusion. Follow-ups confirmed pseudoaneurysm sealing and radial artery patency. Discussion This case illustrates an effective non-surgical approach to managing large-neck pseudoaneurysms post-TRA, utilizing an upsized sheath technique. It underscores the importance of innovative non-surgical strategies in complex cases, providing a safe and effective alternative to traditional management methods. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction and objectives: Distal radial access (DRA) for coronary procedures is currently recognized as an alternative to conventional transradial access, with documented advantages primarily related to access-related complications. However, widespread adoption of DRA as the default approach remains limited. Therefore, this prospective cohort study aimed to present our initial experience with DRA for coronary procedures in any clinical settings. Methods: From August 2020 to November 2023, we included 1000 DRA procedures (943 patients) conducted at a single center. The study enrolled a diverse patient population. We recommended pre- and postprocedural ultrasound evaluations of the radial artery course, with ultrasound-guided DRA puncture. The primary endpoint was DRA success, while secondary endpoints included coronary procedure success, DRA performance metrics, and the incidence of access-related complications. Results: The DRA success rate was 97.4% (n = 974), with coronary procedure success at 96.9% (n = 969). The median DRA time was 40 [interquartile range, 30-60] seconds. Diagnostic procedures accounted for 64% (n = 644) of cases, while 36% (n = 356) involved percutaneous coronary intervention (PCI), including primary PCI in 13% (n = 128). Pre-procedure ultrasound evaluation and ultrasound-guided DRA were performed in 83% (n = 830) and 85% (n = 848) of cases, respectively. Access-related complications occurred in 2.9% (n = 29). Conclusions: This study shows the safety and feasibility of DRA for coronary procedures, particularly when performed under ultrasound guidance in a diverse patient population. High rates of successful access and coronary procedure outcomes were observed, together with a low incidence of access-related complications. The study was registered on ClinicalTrials.gov (NTC06165406).

Objective To investigate the safety of different time decompression in patients undergoing coronary intervention via distal radial artery. Methods From December 2022 to December 2023, a total of 139 patients undergoing coronary intervention through distal radial artery in the department of cardiovascular medicine of the First Affiliated Hospital of Nanjing Medical University were selected and divided into three groups by the random number table method. Group A, 47 cases, underwent first decompression 30 minutes after operation. Group B, 47 cases, underwent initial decompression 1 h after operation. Group C, 45 cases, underwent initial decompression 2 h after operation. Postoperative limb pain score, comfort score and palm-diameter swelling rate immediately after operation, 30 min, 1 h, 2 h and 4 h, and postoperative puncture bleeding were compared among the three groups. Results Immediately after operation, the pain score, comfort score and the swelling rate of the circumference of the palm among the three groups showed no statistical significance (P > 0.05) . The limb pain score of group A at 30 min, 1 h, 2 h and 4 h after operation was lower than that in group B and group C (P < 0.05), and the comfort score was higher than that in group B and group C (P < 0.05) . The swelling rate of the palms of group A at 1 h, 2 h and 4 h after operation was lower than that in group B and group C (P < 0.05) . There was no significant difference in postoperative bleeding among the three groups (P > 0.05) . Conclusion The first decompression within 30 minutes after operation is safe and effective for patients undergoing coronary intervention through distal radial artery, which can significantly relieve pain, swelling discomfort and improve comfort, and is worthy of promotion in clinical work.

Background/Objectives: The distal transradial approach (dTRA) is increasingly used in interventional cardiology. Doppler Ultrasound (DUS) effectively assesses radial artery (RA) characteristics. This study aims to identify specific RA DUS characteristics in patients undergoing coronary procedures via dTRA. Methods: Participants from the ANTARES trial who completed the intervention per-protocol and retained RA patency were included. DUS was performed at baseline, 1 day, and 60 days post-procedure. Results: Among 400 participants, 348 had either dTRA (n = 169) or conventional transradial access (cTRA) (n = 179). Distal RA lumen diameter was 12% smaller than that of the proximal RA (p < 0.001). Men had a 14% larger distal RA diameter than women (2.33 ± 0.31 mm vs. 2.04 ± 0.27 mm, p < 0.0001), similar to the proximal RA relationship. Peak flow velocities were similar between the sexes. Univariate linear regression showed that height, weight, body mass index, and body surface area (BSA) predicted arterial size, with BSA remaining significant in multivariate analysis (beta coefficient 0.62; confidence interval 0.49–0.75; p < 0.0001). Distal RA diameter correlated positively with palpable pulse at the snuffbox and wrist. The dTRA resulted in an immediate 14% and 11% increase in distal and proximal RA diameter, respectively (both p < 0.05). Sixty days after dTRA, the distal RA remained slightly dilated (p < 0.05), while the proximal RA returned to baseline. Conclusions: Distal RA diameter is significantly associated with sex, measuring smaller than the forearm segment. A strong palpable pulse correlates with larger distal RA size. The dTRA induces RA lumen expansion. A thorough understanding of distal RA anatomy is essential for optimizing patient selection and refining techniques for transradial procedures. [ABSTRACT FROM AUTHOR]

Background: To compare distal (dTRA) and classical (cTRA) transradial approaches for coronary catheterization with respect to puncture attempts, puncture time, operator and patient comfort, and safety outcomes. Methods: In this prospective observational study, patients undergoing coronary catheterization for standard indications via dTRA or cTRA approaches from July 2019 to May 2020 were included. Clinicodemographic and laboratory characteristics were recorded. Puncture time, number of puncture attempts, operator and patient comfort on the visual analogue scale (VAS), and access site complications like hematoma and radial artery occlusion were recorded. Patients were analyzed in the same group as the initial puncture, even if there was a cross-over. Results: Of the 130 patients (40.8% women), 50.8% and 49.2% belonged to dTRA and cTRA groups, respectively. dTRA group required more than one puncture attempt more frequently than cTRA group (30.3% vs. 15.6%; P=.047); consequently, puncture time was longer (60s vs. 50s; P=.031, respectively). However, puncture time was comparable if the puncture was successful in the first attempt (47.5s vs. 45s; P=.492). Patient comfort was comparable (7.2 ± 0.9 vs. 7.2 ± 1.2; P=.852), but operator comfort was more with cTRA approach (8.3 ± 1.6 vs. 8.8 ± 1.2; P=.048). Post-procedure, cTRA had more minor bleeding than dTRA approach. There was no major bleeding in either group. The occurrence of radial artery occlusion was comparable in both groups. Conclusion: Although dTRA needed more attempts for successful puncture, puncture time was comparable with cTRA when puncture was successful on the first attempt. Therefore, one attempt at dTRA puncture could be a reasonable approach in patients undergoing coronary catheterization. [ABSTRACT FROM AUTHOR]

Objective To compare and observe the application effects of catheterization through distal transradial approach (dTRA) and conventional transradial approach (TRA) in one-stop coronary and cerebral angiography. Methods Forty-nine participants who underwent selective one-stop coronary and cerebral angiography were randomly divided into the dTRA group (n=24) and TRA group (n=25）. Subjects in the dTRA group underwent "one-stop" coronary and cerebral angiography via catheterization through dTRA; while those in the TRA group received "one-stop" coronary and cerebral angiography via catheterization through TRA. Further observation and comparison were performed on the success rate of catheterization, duration of catheterization, surgical time, X-ray exposure duration, cumulative intraoperative radiation dose, contrast agent dosage, duration of compression hemostasis, postoperative blood oxygen saturation on the index finger, postoperative length of stay in the hospital, VAS scores on postoperative day 1 and day 3, the degree of patient satisfaction and other surgical related data between the two groups as well as the occurrence of postoperative complications such as vasovagal reflex, bleeding at the puncture site, tension hematoma in the right hand and forearm, radial nerve injury, radial artery occlusion, radial artery spasm, and skin ulceration, etc. Results The duration of catheterization and the degree of patient satisfaction in the dTRA group were higher than those in the TRA group, while VAS scores on postoperative day 1 and day 3, and duration of compression hemostasis were lower than those in the TRA group (all P<0. 05）.Furthermore, subjects in both groups did not experience any complications such as vasovagal reflex, bleeding at the puncture site, tension hematoma in the right hand and forearm, radial nerve injury, radial artery occlusion, radial artery spasm, skin ulceration, etc. Conclusions The "one-stop" coronary and cerebral angiography via catheterization through dTRA can alleviate postoperative pain, shorten the duration of compression hemostasis, and improve the degree of patient satisfaction in comparison with the catheterization through TRA. It can be accepted as one of the routine approaches for "one-stop" coronary and cerebral angiography [ABSTRACT FROM AUTHOR]

Background: The transradial artery approach to cerebral angiography can reduce both patient stress following examination and the risk of major complications due to hematoma. Recently, the distal radial artery approach (DRA) has garnered attention in cardiology as a minimally invasive method. DRA is also considered applicable to neurosurgery, although concerns about procedural difficulty and complications persist. Therefore, this study aimed to evaluate the efficacy of the DRA in cerebral angiography and neuroendovascular treatment. Methods: We retrospectively selected 30 consecutive patients for whom the DRA was attempted for cerebral angiography at our hospital. The patients' age, sex, height, weight, and medical history information was collected and correlated with successful puncture and complications. The diameter of the distal radial artery (RA) was measured using ultrasonography. Results: The median patient age was 67 years (range, 32–87 years) and 21 (70%) were men. The median diameter of the distal RA was 2.3 mm (range, 1.7–3.2 mm). Distal RA puncture was successful in 23 patients (77%) and no complications were noted; however there was no significant correlation between successful puncture and any of the patient factors. Carotid artery stenting and preoperative tumor embolization were performed via DRA in six and three cases, respectively. Although puncture site hematoma occurred in only one case, all treatments were successful, and no major complications were observed. Conclusion: DRA can be safely used for cerebral angiography and neuroendovascular treatment. [ABSTRACT FROM AUTHOR]

Radial artery occlusion (RAO), Forearm Hematoma (FH), and compartmental syndrome are three well-recognized complications associated with radial artery (RA) access to percutaneous coronary intervention (PCI). There are disparate ways the RA can be damaged, from multiple needling attempts to adverse interactions between the radial sheath, exchange wire, and diagnostic or guiding catheter with the artery.

Background: This study aims to evaluate the feasibility, efficacy, and safety of distal transradial access (dRA) for the endovascular management of malfunctioning dialysis fistulas. This study also compares dRA with conventional access techniques, such as proximal radial and transvenous access, focusing on technical success, clinical outcomes, and vascular access site complications (VASCs). Methods: A retrospective multicenter study was conducted across four hospitals, including 292 patients treated between January 2019 and June 2024. Of these, 57 patients underwent dRA, and 235 received proximal radial or transvenous access. Key outcomes included technical success (successful completion of the procedure), clinical success (restoration of functional dialysis access), and complication rates. Data were collected on procedure times and complication profiles. Results: Technical success was achieved in 96.5% of patients undergoing dRA, compared to 98.3% in those receiving conventional access (p = 0.388). Clinical success was similar between groups (96.5% vs. 97%, p = 0.835). The overall complication rate was 10.5% for dRA and 8.5% for conventional access (p = 0.632). Cannulation time was longer for dRA (109.1 vs. 91.9 s, p < 0.001), but total procedure duration was comparable between the groups. No major complications were observed in either cohort, and improved post-procedure access flow rates were recorded in all patients. Conclusions: Distal transradial access is a feasible and effective approach for the endovascular management of malfunctioning dialysis fistulas, with outcomes comparable to conventional access techniques. It provides a safe alternative, particularly for patients with complex fistulas, while maintaining a low complication profile.

Background/Objectives: The distal transradial approach (dTRA) is increasingly used in interventional cardiology. Doppler Ultrasound (DUS) effectively assesses radial artery (RA) characteristics. This study aims to identify specific RA DUS characteristics in patients undergoing coronary procedures via dTRA. Methods: Participants from the ANTARES trial who completed the intervention per-protocol and retained RA patency were included. DUS was performed at baseline, 1 day, and 60 days post-procedure. Results: Among 400 participants, 348 had either dTRA (n = 169) or conventional transradial access (cTRA) (n = 179). Distal RA lumen diameter was 12% smaller than that of the proximal RA (p < 0.001). Men had a 14% larger distal RA diameter than women (2.33 ± 0.31 mm vs. 2.04 ± 0.27 mm, p < 0.0001), similar to the proximal RA relationship. Peak flow velocities were similar between the sexes. Univariate linear regression showed that height, weight, body mass index, and body surface area (BSA) predicted arterial size, with BSA remaining significant in multivariate analysis (beta coefficient 0.62; confidence interval 0.49–0.75; p < 0.0001). Distal RA diameter correlated positively with palpable pulse at the snuffbox and wrist. The dTRA resulted in an immediate 14% and 11% increase in distal and proximal RA diameter, respectively (both p < 0.05). Sixty days after dTRA, the distal RA remained slightly dilated (p < 0.05), while the proximal RA returned to baseline. Conclusions: Distal RA diameter is significantly associated with sex, measuring smaller than the forearm segment. A strong palpable pulse correlates with larger distal RA size. The dTRA induces RA lumen expansion. A thorough understanding of distal RA anatomy is essential for optimizing patient selection and refining techniques for transradial procedures.

As a new approach for percutaneous coronary intervention, distal transradial approach (dTRA) is increasingly applied in clinical practice. Thus dTRA is superior to transradial artery approach in improving patient and surgeon comfort, reducing the incidence of complications and forearm arterial injuries, while it also has many limitations, such as lower success rate, longer learning cycle, higher level of puncture site pain, and relatively higher incidence of radial artery spasm. And dTRA has also been used as an approach for acute coronary syndrome and complex percutaneous coronary intervention. But it still needs further verification whether dTRA is suitable for mass promotion and application. This paper reviews and analyzes the strengths, weaknesses, opportunities and challenges of dTRA, in order to provide a theoretical basis for scientific and rational application of dTRA in percutaneous coronary intervention.

Background Cerebral angiography is an important means for the assessment of cerebrovascular diseases. In recent years, distal transradial artery approach (dTRA) has gradually been used in cerebral angiography, but there are few reports on its effectiveness and safety. Objective To compare the effectiveness, patient safety and satisfaction between transradial artery approach (TRA) and dTRA in cerebral angiography. Methods Totally 135 patients who were hospitalized in Department of Neurosurgery, Wujin Hospital Affiliated to Jiangsu University from January 2020 to June 2022 for cerebral angiography were selected. They were divided into TRA group (n=72) and dTRA group (n=63) by the approach used in cerebral angiography, and the puncture time, duration of cerebral angiography, puncture success rate, X-ray exposure time, incidence of puncture site complications and serious cardiovascular and cerebrovascular events within three days after cerebral angiography, and levels of pain and satisfaction within 24 hours after cerebral angiography were compared between the groups. Results The mean puncture time in dTRA group was much longer than that of TRA group (P0.05) . No serious cardiovascular and cerebrovascular events occurred in both groups within three days after cerebral angiography. dTRA group had much lighter pain level and significantly higher satisfaction within 24 hours after cerebral angiography than TRA group (P

Background The incidence of radial artery occlusion (RAO) after coronary intervention via transradial artery approach (TRA) is high. But there is a lack of long-term follow-up studies with a large sample size on retrograde recanalization of occluded radial artery via distal transradial artery approach (dTRA) . Objective To assess the feasibility of dTRA for retrograde recanalization of occluded radial artery. Methods Forty-four patients undergoing retrograde recanalization via dTRA for treating RAO after coronary intervention via TRA were consecutively recruited from Shenzhen People's Hospital from June 2019 to December 2021. The primary observation index was postprocedural radial artery patency. And secondary observation index included possible predictors of failed retrograde recanalization, incidence of adverse events during hospitalization, and patency rates of radial artery at 3, 6 and 12 months after procedure. Results The success rate of postprocedural radial artery patency was 88.6% (39/44) , and divided into groups of successful (n=39) and failed (n=5) according to the result of the procedure. Compared with the successful group, the failed group had higher percentages of diabetics, current smokers and chronic total occlusion of the coronary artery, as well as a significantly lower prevalence of undergoing balloon angioplasty (P0.05) . The patency rates of radial artery in successful group were 48.7% (19/39) , 43.6% (17/39) , and 35.9% (14/39) at 3, 6, and 12 months after procedure, respectively. Conclusion The dTRA may be feasible for retrograde recanalization of occluded radial artery, which showed a high procedural success rate up to 88.6%, but the long-term patency rate was less than 50.0%. Diabetes, smoking, times of coronary interventions, chronic total occlusion of coronary artery, and receiving no balloon angioplasty may be influencing factors of failed retrograde recanalization of occluded radial artery via dTRA. And dTRA for retrograde recanalization of occluded radial artery is recommended for patients with RAO who also require elective coronary intervention.

Percutaneous coronary diagnosis and intervention via distal transradial artery approach has become one of the hot research topics in the field of coronary angiography and intervention. Compared with transradial approach, the distal transradial artery approach has the advantages of higher patient comfort and fewer related complications; however, due to the tortuosity of radial artery and relatively small size of distal radial artery, there is a significant learning curve for distal transradial artery approach puncture. This paper analyzes and summarizes the common causes (mainly including patient factors and operational factors) and treatment strategies of distal transradial artery approach puncture failure based on the experience of more than 2 000 cases, in order to provide a reference for improving the success rate of puncture and promoting the application of distal transradial artery approach.

Background Percutaneous coronary intervention (PCI) via distal transradial artery approach (dTRA) is effective in reducing the incidence of radial artery occlusion, however, there are no reports on the feasibility, safety and timing of secondary PCI via dTRA domestically. Objective To explore the feasibility, safety and timing of secondary PCI via dTRA. Methods A total of 70 patients who were to undergo secondary PCI via dTRA in Fuwai Hospital, CAMS&PUMC from July 2021 to July 2022 were consecutively included and divided into ≤30 d group (n=33) and >30 d group (n=37) according to the time interval since the last PCI via dTRA. The general clinical data, operation-related indicators, coronary artery lesions and radial artery inner diameters at 5, 10 and 15 cm proximal to the radial styloid process before and 24 h after PCI were compared between the two groups. Results The dTRA puncture and catheterization were successfully conducted in 69 of 70 patients, with a success rate of 98.6% (69/70) . Second PCI via dTRA was successfully completed in 66 of 67 patients assessed for secondary PCI, with a success rate of 98.5% (66/67) . There were significantly difference in age, platelet count, incidence of diabetes, number of lesioned vessels and ACC/AHA coronary artery lesions typing (P30 d group before and 24 h after PCI when comparing between the two groups, respectively (P30 d group (P30 days from the first dTRA PCI) , and the timing of secondary PCI via dTRA should be determined according to the patient's condition and puncture site.

Vascular access through the distal radial artery, an innovative method for accessing the coronary arteries, is gaining popularity due to its substantial benefits, including a reduction in vascular complications and enhanced comfort for both the patient and the operator. The distal radial puncture technique was introduced in 1982 for anesthesia and adopted in interventional cardiology in the late 1990s. Researchers have published promising results, supporting the efficacy and safety of this method. This technique offers several advantages, the most interesting being the preservation of the proximal radial artery, the comfort of the patient and the operator, and a reduced hemostasis time favoring the ambulatory aspect of the procedures. However, a learning curve is required, but it is comparable to the one observed during the first use of the proximal radial artery. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the difference in impact between distal transradial access (dTRA) and classical transradial access (TRA) on vascular function using flow-mediated vasodilation (FMD) following coronary diagnostic and therapeutic catheterizations.

Left distal transradial artery (dTRA) access in the anatomical snuffbox is a relatively novel technique and is considered beneficial when left TRA access is required. This technique offers essential advantages, including improved patient comfort and lower vascular complications. dTRA may provide an entry site for retrograde recanalization of the radial artery. We presented a case of a 65-year-old man with 5-stage chronic kidney disease (CKD) and had left a radio-cephalic arteriovenous fistula (AVF) for routine hemodialysis. There was obstruction of AVF a month after creation. The vascular intervention has been performed using left dTRA access for retrograde recanalization. Angiogram showed cephalic vein obstruction and non-significant stenosis of the proximal radial artery. Percutaneous transluminal angioplasty was successful in improving cephalic vein flow. Hemostatic performed without a hemostatic device. This case report highlights the dTRA access approach in the anatomical snuffbox to recanalize AVF occlusion in the wrist in a patient with CKD.

Background: The distal radial artery has emerged as an alternative vascular-access site to conventional transfemoral and transradial approaches. The main advantage over the conventional transradial route is the reduced risk of radial artery occlusion, especially in those patients who, for various clinical reasons, have to undergo repeated endovascular procedures. This study aims to assess the efficacy and safety of distal radial access for transcatheter arterial chemoembolization of the liver. Methods: This investigation is a single-center retrospective analysis of 42 consecutive patients who had undergone, from January 2018 to December 2022, transcatheter arterial chemoembolization of the liver with distal radial access for intermediate-stage hepatocellular carcinoma. Outcome data were compared with a retrospectively constituted control group of 40 patients undergoing drug-eluting beads-transcatheter arterial chemoembolization with femoral access. Results: Technical success was achieved in all cases, with a 2.4% conversion rate for distal radial access. A superselective chemoembolization was performed in 35 (83.3%) cases of distal radial access. No episode of radial artery spasm or radial artery occlusion occurred. No significant differences in efficacy and safety were observed between the distal radial access group and the femoral access group. Conclusions: Distal radial access is effective, safe, and comparable to femoral access in patients undergoing transcatheter arterial chemoembolization of the liver. [ABSTRACT FROM AUTHOR]

Distal transradial approach (dTRA) for neuroendovascular procedures has received much attention in recent years as a newer and less invasive alternative to the conventional transfemoral or transradial approaches. We present the case of an 89-year-old woman with a basilar artery aneurysm requiring simultaneous catheterization of the bilateral vertebral arteries who was successfully embolized using bilateral dTRA. The aneurysm was accessed from the right vertebral artery using the right dTRA. Control angiograms during the procedure were performed from the left vertebral artery via the left dTRA. The operator's posture was ergonomically comfortable, and the catheters were easy to handle during the procedure. To the best of our knowledge, this is the first case of a bilateral dTRA used for neuroendovascular procedures. Bilateral dTRA is a safe and minimally invasive method for patients and ergonomically comfortable for operators.

Background: The distal radial artery (dRA) approach at anatomical snuff box has gained attention of the interventional cardiologist in last few years. The procedural success rate by this novel approach depends on size of the radial artery and therefore the study was planned to study the size of distal radial artery. Methods: Total of 1004 patients of >18 years of age undergoing coronary catheterization were included in the study. The vessel diameter was measured from media to media in the anatomical snuff box a day prior to coronary catheterization. Results: The mean diameter of right radial artery at conventional access site was 2.56 ± 0.35 mm and at distal access site 2.23 ± 0.39 mm (p

Background: Compared with the conventional transradial approach (TRA), there are limited data on the efficacy and safety of the novel distal transradial approach (DTRA). This study aimed to verify the effectiveness and safety of the DTRA for percutaneous coronary angiography and intervention. Besides, we also try to highlight the potential of the DTRA in reducing radial artery occlusion (RAO), shorter time to hemostasis, and improved patient comfort. Methods: This single-center prospective observational study enrolled patients treated with DTRA (n = 527) in the first 9 months and with TRA (n = 586) in the next 8 months from May 2020 to December 2021. The primary endpoint was the proximal RAO rate at 30 days. Results: Baseline data were similar between the two groups. The proximal radial artery occlusion rate at 30 days [2.3% vs. 7.0%], the success rate of puncture [86.4% vs. 96.7%], the Numeric Rating Scale score [1.97 ± 1.89 vs. 4.61 ± 2.68], and the incidence of postoperative subcutaneous hematoma and finger numbness [3.4% vs. 8.2%, 2.7% vs. 4.4%] were lower. The puncture time [6.93 ± 7.25 min vs. 3.18 ± 3.52 min] was longer, and the time until radial compression device removal was shorter [CAG: 138.61 ± 38.73 min vs. 191.6 ± 61.22 min, PCI:221.46 ± 62.45 min vs. 276.28 ± 76.39 min] in the DTRA group than TRA group (all P

Shan-Shan Li,1,&ast; Jian-Ming Li,2,&ast; Ling-Ling Liu,1 Wei Liu,1 Hao Yang,1 Chun-Guang Feng1 1Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China; 2Department of Cardiac Surgery, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chun-Guang Feng, Department of Cardiology, Xuzhou Central Hospital, Xuzhou, 221009, People’s Republic of China, Tel +86 18936376559, Email fengcg8r@163.comObjective: The aim of this study was to explore the factors influencing the success rate of distal transradial access (dTRA) for coronary intervention.Methods: A total of 246 patients who underwent either coronary angiography or percutaneous coronary intervention in the Xuzhou Central Hospital were enrolled in this study. Access via the distal radial artery was the first choice for the procedure, and the success rate of this approach was recorded. All patients underwent color Doppler ultrasonography of the distal radial artery at the right anatomical snuff box in order to measure the artery diameter. The patients were divided into two groups depending on the success of the dTRA; 44 patients with unsuccessful punctures were assigned to the observation group and 202 patients with successful punctures acted as the control group. The basic clinical data of the two groups were recorded, and the differences between the two groups with respect to various indices were evaluated. Logistic regression analysis was carried out to explore the factors influencing the success rate of dTRA.Results: Of the 246 patients, dTRA was achieved in 202, giving a puncture success rate of 82.11%. Logistic regression analysis showed that the success rate of dTRA was positively correlated with the diameter of the distal radial artery (odds ratio [OR] = 3.381, P = 0.005) and hypertension (OR = 2.427, P = 0.016), and negatively correlated with female gender (OR = 0.429, P = 0.036) and diabetes mellitus (OR = 0.325, P = 0.002).Conclusion: The results of this study suggest that hypertension and distal radial artery diameter have a positive effect on the success rate of dTRA, while diabetes and female gender have a negative effect.Keywords: distal radial artery, coronary angiography, color Doppler, inner diameter, puncture success rate, coronary atherosclerotic heart disease, regression analysis

Abstract Background The novel distal radial artery (dRA) approach is a popular arterial access route for interventional cardiology and neurointerventions. We explored the dRA as an alternative site to the classic forearm radial artery (RA) for perioperative blood pressure monitoring. We hypothesized that dRA catheterization is noninferior to RA for the first attempt success rate. Methods This was a single-center, prospective, randomized controlled, noninferiority study. Adult patients who underwent elective surgery at the Jinling Hospital from May 2021 to August 2021 were enrolled. The primary endpoint was to test the noninferiority of the first attempt success rate between the groups. Secondary endpoints included anatomical characteristics, catheterization time, arterial posterior wall puncture rate, postoperative compression time, dampened arterial pressure waveforms, and complications. Results Totally, 161 patients who received either dRA (n = 81) or RA (n = 80) catheterization were analyzed. The first attempt success rates were 87.7 and 91.3% in the dRA and RA groups, respectively, with a mean difference of − 3.6% (95% CI, − 13.1 to 5.9%). The dRA diameter and cross-sectional area were significantly smaller than those of the RA (P

Background: The fundamental principle of ayurveda is the tridosha theory (three doshas). These dosha are the causative and governing bio-energies responsible for the formation of body constitution. The vata dosha dominant personality have classical features like a small body frame when compared to kapha with large body built and broad anatomical structures. Pittaja body constitution has medium body built with reddish colouration and sharp features. Aim: This study aimed to correlate the radial artery intima-media thickness (IMT) and luminal diameter (LD) and further study its association with different body constitution (prakriti) and check the difference between the groups of prakriti. Methods: This observational cross-sectional study was done between May 2021 and June 2021 in the Department of Radiology, KLE Prabhakar Kore Charitable Hospital, Belagavi. Non-randomly selected volunteers ≥23 ±5years (n = 35) were divided into body constitution (prakriti) groups and evaluated for the IMT, LD (luminal diameter) of the radial artery using B-mode ultrasonography. Pearson’s co-relation was used to test the corelation between the luminal diameter and intimae media thickness of distal radial artery. Chi-square test of independence was used to check the association between luminal diameter and intimae media thickness of distal radial artery with body constitution. One-way ANOVA was used to study the difference between the groups of prakriti. Results: The mean luminal diameter (LD) in vataja body constitution (5%) was 1.450 ± 0.495 mm, pittaja body constitution (11%) was 1.750±0.10 mm, kaphaja constitution (11%) was 1.70± 0.30 mm, vatapittaja body constitution (11%) was 4.15±0.47 mm, vatakaphaja body constitution (26%) was 1.64±0.83 mm, pittakaphaja constitution (23%) as 2.3±0.15 mm and samadhatuja constitution (11%) had 1.8±0.189 mm. The mean intima media thickness (IMT) in vataja body constitution (5%) was 0.05± 0 mm, pittaja body constitution (11%) was 0.03±0 mm, kaphaja constitution (11%) was 0.05± 0.014 mm, vatapittaja body constitution (11%) was 0.107±0.09 mm, vatakaphaja body constitution (26%) was 0.83±0.07 mm, pittakaphaja constitution (23%) was 0.313±0.006 mm and samadhatuja constitution (11%) had 0.350 ± 0.012 mm. As per the analysis a low positive Pearson’s correlation was found between IMT and LD (r = 0.254) between the luminal diameter (LD) and intima medial thickness (IMT) of distal radial artery. Chi square test of independence has shown significant association between DRA dimensions (IMT, LD) and body constitution (prakriti), palpatory blood vessel consistency. Among the observed values the vatakaphaja body constitution (0.83±0.07 mm) had increased intima media thickness (IMT). Among all the observed values the vatapittaja body constitution had broadest DRA luminal diameter (LD) of 4.15±0.47mm. One way ANOVA showed no significant difference between the groups of prakiti and IMT, LD of distal radial artery. Conclusion: As per the observations of the present study different body constitution (prakriti) did not show any significant impact on distal radial artery dimensions (IMT and LD) as there are various factors like hormones, neural, blood volume regulators involved in vascular constriction and dilation. The prakriti assessment is a strong marker for prediction and the early diagnosis of diseases. This body constitution (prakriti) of an individual is the basic constituent on which the pulse wave variability of distal radial artery (DRA) acts.

Objective: The implications of saline flushing of the radial sheath have not been studied in terms of radial artery occlusion. We aimed to investigate radial artery patency outcomes after the saline flush of the radial sheath., Methods: In this prospective observational study, patients were selected to receive either radial sheath flushing with 10 mL of saline after pulling the sheath to one-third of its length (Group 1) or standard care (Group 2) after removal of the catheter sheath as per physician discretion. Radial artery patency was assessed by Doppler ultrasound at 24 h and 30 days after the procedure., Results: A total of 2877 patients were enrolled in the study, with 1340 receiving radial sheath flushing and 1537 receiving standard care. At 24 h after the procedure, the incidence of radial artery occlusion was significantly lower in the radial sheath flushing group compared to the standard care group (4.4% vs 12.6%, p  = 0.027). This difference persisted 30 days after the procedure (6.1% vs 15.8%, p  = 0.015). Radial sheath flushing was independently associated with a lower risk of radial artery occlusion 30 days after the procedure, after adjusting for potential confounders (OR 0.375, 95% CI 0.18-0.77, p  = 0.008)., Conclusion: In conclusion, this prospective study provides evidence to support the use of radial sheath flushing after coronary intervention via the radial artery as a simple and effective strategy for reducing the risk of radial artery occlusion without increasing the risk of other adverse outcomes., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The distal radial artery (DRA) approach has emerged as a new approach in cardiovascular intervention. In recent years, ultrasound has been widely used in cardiovascular intervention via the DRA approach. This article systematically discusses the progress of ultrasound in the preoperative vascular assessment, intraoperative guided puncture and postoperative observation of complications via the DRA approach.

BackgroundCompared with traditional trans-radial artery access (TRA), there are limited data that can confirm the efficacy and safety of a 7F thin-walled sheath placed via distal TRA (dTRA) for percutaneous coronary intervention (PCI).ObjectiveThis study aims to analyze the safety and efficacy of the placement of a 7F thin-walled sheath via dTRA for PCI.MethodsThis was a single-center retrospective observational study in which 102 patients who received complex PCIs with a 7F thin-walled sheath placed via dTRA in the catheter room of our hospital from May 2020 to October 2021 were included. The basic information, puncture success rate, radial artery occlusion (RAO) rate, radial artery lumen diameter and area, surgical data, pain score, and complication rate were observed and recorded.ResultsThe puncture success rate was 90.2% in the 102 patients, and the success rate of the operation was 97.8% among 92 patients with a successful puncture. The PCIs for patients included emergency PCIs and all types of complex PCIs. Color Doppler ultrasound performed at 1 and 30 d after the procedure showed that the RAO rate was 2.2%, the distal RAO rate was 3.3%, the postoperative average pain score was 2.2 points, and there were five patients (5.4%) with local hematoma, all of which were grade 1–2. Radial artery spasm and nervous injury occurred in two patients (2.2%), and arteriovenous fistula occurred in one patient (1.1%). Radial artery perforation, radial artery dissection, pseudoaneurysm, and sheath kinking did not occur.ConclusionThe placement of a 7F thin-walled sheath via dTRA for PCI showed a high puncture and procedural success rate, a low postoperative RAO rate, and a low incidence of local hematoma and other complications. The placement of a 7F Glidesheath Slender®via dTRA for PCI is safe and feasible.

Anatomical snuff box or distal radial artery approach for various percutaneous coronary angiograms and interventions has gained increased interest in recent years. The main advantage is the ergonomic comfort to the patient as it allows the patient's arm to be in more natural position. The safety and feasibility of this novel approach has been studied in past few years but still the data is limited and the distal radial artery approach has not been included in the guidelines. The present review focuses on the latest evidence, technique, advantages and disadvantages of this distal radial artery access.

Aims: :To evaluate safety and efficacy of distal right radial access (DRRA) compared to right radial access (RRA), for coronary procedures, in patients with smaller diameter radial arteries (SDRA) (radial artery diameter (RAD)

Background: The novel distal radial artery (dRA) approach is a popular arterial access route for interventional cardiology and neurointerventions. We explored the dRA as an alternative site to the classic forearm radial artery (RA) for perioperative blood pressure monitoring. We hypothesized that dRA catheterization is noninferior to RA for the first attempt success rate. Methods: This was a single-center, prospective, randomized controlled, noninferiority study. Adult patients who underwent elective surgery at the Jinling Hospital from May 2021 to August 2021 were enrolled. The primary endpoint was to test the noninferiority of the first attempt success rate between the groups. Secondary endpoints included anatomical characteristics, catheterization time, arterial posterior wall puncture rate, postoperative compression time, dampened arterial pressure waveforms, and complications. Results: Totally, 161 patients who received either dRA (n = 81) or RA (n = 80) catheterization were analyzed. The first attempt success rates were 87.7 and 91.3% in the dRA and RA groups, respectively, with a mean difference of − 3.6% (95% CI, − 13.1 to 5.9%). The dRA diameter and cross-sectional area were significantly smaller than those of the RA (P < 0.001). The subcutaneous depth of dRA was significantly greater than that of the RA (P < 0.001). The dRA had a longer catheterization time (P = 0.008) but a shorter postoperative compression time (P < 0.001). The arterial posterior wall puncture rate of dRA was significantly higher than that of the RA (P = 0.006). The dRA had fewer dampened arterial waveforms than RA (P = 0.030) perioperatively. Conclusions: The dRA is a rational alternative approach to RA for perioperative arterial pressure monitoring and provides a noninferior first attempt success rate. Trial registration: This study is registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2100043714, registration date: 27/02/2021). [ABSTRACT FROM AUTHOR]

Background: Radial artery (RA) catheterization is the access of choice over femoral artery access for most interventional vascular procedures given its safety and faster patient recovery. There has been growing interest in distal radial artery (dRA) access as an alternative to the conventional proximal radial artery (pRA) access. Preserving the RA is important which serves as a potential conduit for future coronary artery bypass surgery, dialysis conduit or preserve the artery for future cardiovascular procedures. The dRA runs in close proximity to the radial nerve, which raises the concern of potential detrimental effects on hand function.Study Design: The Distal versus Proximal Radial Artery Access for cardiac catheterization and intervention (DIPRA) trial is a prospective, randomized, parallel-controlled, open-label, single center study evaluating the outcomes of hand function and effectiveness of dRA compared to pRA access in patients undergoing cardiac catheterization. The eligible subjects will be randomized to dRA and pRA access in a (1:1) fashion. The primary end point is an evaluation of hand function at one and twelve months follow-up. Secondary end points include rates of access site hematoma, access site bleeding, other vascular access complications, arterial access success rate, and RA occlusion at one and twelve months follow up.Conclusion: Effects of dRA on hand function remains unknown and it's use questionable in the presence of a widely accepted pRA. DIPRA trial is designed to determine the safety and effectiveness of dRA for diagnostic and interventional cardiovascular procedures compared to the standard of care pRA. [ABSTRACT FROM AUTHOR]

This study aimed to compare the efficacy and safety of the distal transradial approach (dTRA) versus the conventional transradial approach (TRA) for coronary angiography and percutaneous coronary interventions. The recommended approach for coronary procedures is TRA. However, it is associated with radial artery occlusion (RAO). The dTRA could potentially decrease the incidence of RAO. One thousand forty-two consecutive patients were randomized (1:1) to right dTRA or TRA. The primary endpoint was the rate of RAO, which was evaluated by Doppler ultrasound at 60 days after randomization. Five hundred eighteen and 524 patients were randomized to dTRA and TRA, respectively. Follow-up Doppler evaluation of the radial artery was accomplished in 404 (78.0%) patients in the dTRA group and 392 (74.8%) in the TRA group. The rate of RAO was significantly reduced in the dTRA group compared with TRA group (3.7% vs 7.9%, respectively; P = 0.014). The rate of successful sheath insertion was lower in the dTRA group compared with the TRA group (78.7% vs 94.8%, respectively; P < 0.001). More punctures (median = 2 [IQR: 1-3] vs median = 1 [IQR: 1-2]; P < 0.001) and a longer time (120 vs 75 seconds; P < 0.001) were required for sheath insertion in the dTRA group compared with the TRA group. The hemostasis time was shorter in the dTRA group compared with the TRA group (60 vs 120 minutes; P < 0.001). The dose area product was higher in the dTRA group (median = 32,729 in the dTRA vs 28,909 cGy/cm2 in the TRA group; P = 0.02). No significant differences were observed in the secondary safety endpoints (bleeding [Bleeding Academic Research Consortium ≥2] and severe radial artery spasm). According to our study, dTRA was associated with a lower rate of forearm RAO, a shorter time of hemostasis, a higher crossover rate and dose area product, and a longer procedural time compared with TRA. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The fundamental principle of ayurveda is the tridosha theory (three doshas). These dosha are the causative and governing bio-energies responsible for the formation of body constitution. The vata dosha dominant personality have classical features like a small body frame when compared to kapha with large body built and broad anatomical structures. Pittaja body constitution has medium body built with reddish colouration and sharp features. Aim: This study aimed to correlate the radial artery intima-media thickness (IMT) and luminal diameter (LD) and further study its association with different body constitution (prakriti) and check the difference between the groups of prakriti. Methods: This observational cross-sectional study was done between May 2021 and June 2021 in the Department of Radiology, KLE Prabhakar Kore Charitable Hospital, Belagavi. Non-randomly selected volunteers ≥23 ±5years (n = 35) were divided into body constitution (prakriti) groups and evaluated for the IMT, LD (luminal diameter) of the radial artery using B-mode ultrasonography. Pearson's co-relation was used to test the corelation between the luminal diameter and intimae media thickness of distal radial artery. Chi-square test of independence was used to check the association between luminal diameter and intimae media thickness of distal radial artery with body constitution. One-way ANOVA was used to study the difference between the groups of prakriti. Results: The mean luminal diameter (LD) in vataja body constitution (5%) was 1.450 ± 0.495 mm, pittaja body constitution (11%) was 1.750±0.10 mm, kaphaja constitution (11%) was 1.70± 0.30 mm, vatapittaja body constitution (11%) was 4.15±0.47 mm, vatakaphaja body constitution (26%) was 1.64±0.83 mm, pittakaphaja constitution (23%) as 2.3±0.15 mm and samadhatuja constitution (11%) had 1.8±0.189 mm. The mean intima media thickness (IMT) in vataja body constitution (5%) was 0.05± 0 mm, pittaja body constitution (11%) was 0.03±0 mm, kaphaja constitution (11%) was 0.05± 0.014 mm, vatapittaja body constitution (11%) was 0.107±0.09 mm, vatakaphaja body constitution (26%) was 0.83±0.07 mm, pittakaphaja constitution (23%) was 0.313±0.006 mm and samadhatuja constitution (11%) had 0.350 ± 0.012 mm. As per the analysis a low positive Pearson's correlation was found between IMT and LD (r = 0.254) between the luminal diameter (LD) and intima medial thickness (IMT) of distal radial artery. Chi square test of independence has shown significant association between DRA dimensions (IMT, LD) and body constitution (prakriti), palpatory blood vessel consistency. Among the observed values the vatakaphaja body constitution (0.83±0.07 mm) had increased intima media thickness (IMT). Among all the observed values the vatapittaja body constitution had broadest DRA luminal diameter (LD) of 4.15±0.47mm. One way ANOVA showed no significant difference between the groups of prakiti and IMT, LD of distal radial artery. Conclusion: As per the observations of the present study different body constitution (prakriti) did not show any significant impact on distal radial artery dimensions (IMT and LD) as there are various factors like hormones, neural, blood volume regulators involved in vascular constriction and dilation. The prakriti assessment is a strong marker for prediction and the early diagnosis of diseases. This body constitution (prakriti) of an individual is the basic constituent on which the pulse wave variability of distal radial artery (DRA) acts. [ABSTRACT FROM AUTHOR]

Background: The femoral artery is the standard route for transarterial chemoembolization (TACE); however, it is negatively associated with the quality of life of patients, and carries an increased risk of deep vein thrombosis in the lower limbs. We employed the distal radial approach to TACE to assess its feasibility and safety., Methods: We conducted a retrospective study at the First Hospital of Jilin University from August 1, 2020 to October 31, 2023. To be eligible for inclusion in the study, the patients had to meet the following main inclusion criteria: (I) have undergone a preoperative imaging (abdominal computed tomography enhancement or magnetic resonance dynamic enhancement) examination, or have a pathologically confirmed diagnosis of primary liver cancer, and a Child-Pugh score of A or B; and (II) have undergone distal radial artery puncture. The primary endpoint of this study was the success rate of distal radial artery puncture. The secondary endpoints were complications and the duration of the puncture., Results: Among the 343 patients with primary liver cancer (of whom 236 were male and 107 were female), a total of 1,315 distal radial artery punctures were attempted. The success rate was remarkably high at 95.13% (1,251/1,315), with only 64 cases requiring an alternative approach due to failed puncture. The average puncture duration was 20±7.43 minutes. No bleeding and hematoma, no arterial dissection and pseudoaneurysm formation were observed on ultrasound, and the radial pulse was palpable in all patients, highlighting the safety of the procedure. Further, no adverse events of vascular occlusion were observed among the 12 patients who received 6 or more punctures, indicating the sustainability of the distal radial artery access under the premise of adequate vascular protection. The development of this technique requires a learning curve of at least 50 cases to break through the learning baseline and be proficient in distal radial artery blind puncture. This may be the reason why many interventional physicians are reluctant to perform this procedure, adapting to the femoral approach with a shorter learning curve., Conclusions: The distal radial artery approach is feasible and safe in hepatic arterial chemoembolization, and should be widely promoted in TACE., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-24-1231/coif). All authors report that this work was supported by the Jilin Provincial Health Science and Technology Capacity Improvement Project (No. 2023LC009). The authors have no other conflicts of interest to declare., (2024 Translational Cancer Research. All rights reserved.)

Introduction: The distal radial artery presents a particular challenge for puncture and catheterization due to its diminutive size, tortuous path, and tendency to spasm, increasing the risk of procedural failure and injury. Ultrasound guidance improves success rates and reduces risk in radial artery catheterization. This study evaluates the efficacy and safety of a refined dynamic needle tip positioning technique for distal radial artery access., Methods: One hundred twelve patients were randomized to either the modified dynamic needle tip positioning technique (MDNTP) or palpation guidance groups (palpation group), each with 56 participants. The primary outcomes were the success rate of the initial puncture and overall puncture success rate, while secondary outcomes included procedural time and complications such as puncture site hematoma and radial artery occlusion within 24 h., Results: The MDNTP group exhibited superior initial puncture success (71.43% vs 46.43%, p  < 0.05) and fewer puncture attempts (median 1 (1, 2) vs 2 (1, 4), p  < 0.05), resulting in a higher overall puncture success rate (98.21% vs 87.50%, p  = 0.028). Notably, sheath insertion times were significantly shorter (17 (12, 21) s vs 57 (32, 100) s, p  = 0.001) and the Sheath insertion success rate was higher (96.43% vs 82.14%, p  = 0.015) in the MDNTP group. Furthermore, the incidence of puncture site hematomas was reduced (5.36% vs 19.64%, p  = 0.022), although puncture time was longer (60 (28, 116) s vs 40 (15, 79) s, p  = 0.033). Despite these differences, total procedural time and the incidence of radial artery occlusion at 24 h postoperatively were comparable between the two groups., Conclusion: The MDNTP technique boosts the success of distal radial artery puncture and catheterization, reducing the risk of complications associated with the procedure., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Pseudoaneurysms are not uncommon in the clinic, but they have rarely been reported as a result of distal radial artery puncture. This case report is about an elderly woman who developed a pseudoaneurysm at the distal radial artery puncture site after coronary angiography via the distal radial artery. After timely treatment and long-term follow-up, the patient's hand wound gradually healed., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Xie et al.)

The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p < 0.0008). Successful catheterization was achieved in 98% for the CRA group and in 88% for the DRA group (p = 0.008). Radial artery occlusion, detected by ultrasonography, was found in 3 patients in the CRA group (3.1%) and nobody in the DRA group (p = 0.25). The median diameter of the radial artery diameter was higher in the DRA than the CRA group (2.2 mm vs 2.1 mm; p = 0.007). The distal radial approach is feasible and safe for coronary angiography and interventions, but needs a learning curve. [ABSTRACT FROM AUTHOR]

Percutaneous coronary intervention (PCI) via the distal radial access (DRA), called as snuffbox approach, recently has been increased worldwide due to fewer complications. Generally, since the diameter of distal radial artery is smaller than the radial artery, it is expected that the hemostasis duration can be shortened; however, there are no prospective studies. Furthermore, there is a lack of data about the feasibility of DRA for PCI. We prospectively collected data from 250 patients who were performed PCI via the DRA by three multi-center operators between March 2019 and December 2019. The primary outcome was hemostasis duration. Secondary outcomes were success rate of PCI, cannulation time, and puncture site complications. Mean age of study population was 65.1 ± 10.3 years, success rate of PCI via the DRA was 99.2% (250/252) and 91.2% (228/250) patients was performed PCI via 6-French sheath. The cannulation time was 131 ± 98 s and the average hemostasis duration was 199 ± 50 min, and the median time was 180 [180–200] min. There are few minor hematomas (8.0%) and puncture site numbness (1.6%) with no radial artery occlusion. HEMOBOX trial first reported hemostasis duration for PCI using the DRA, approximately 3 h, with 99.2% success rate and few minor complications. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03863652 • Successful hemostasis was achieved approximately 3 h after PCI via the DRA. • This new approach showed a high success rate of PCI and an absence of major access-site complications. • The DRA could be suitable for the alternative access-site for PCI in selected patients, such as those with a very high bleeding risk. [ABSTRACT FROM AUTHOR]

Purpose: To report use of distal radial artery (dRA) access for carotid artery stenting (CAS) and to discuss procedural setup and technical considerations for a successful intervention. Methods: A retrospective review of our prospective neurointerventional database of CAS was conducted between May 2019 and March 2020. All CAS cases via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data was collected. Results: 22 CAS procedures in 20 patients via dRA were identified. Patients' mean age was 69.4 years (range 53–87 years). 3 patients were female. Mean radial artery diameter was 2.1 mm (range 1.6–2.8 mm). dRA access was achieved in all cases. Conversion to femoral access was required in 2 cases (9.1%) due to persistent radial artery vasospasm resulting in patient discomfort despite multiple additional doses of intraarterial vasodilators and added intravenous sedation as well as tortuous vessel anatomy and limited support of the catheters in a type 3 aortic arch for left CAS. Conclusion: Our preliminary experience with dRA access for CAS suggests this approach to be feasible and safe for patients. Technical considerations are important and preprocedural planning is necessary for a successful intervention. Catheter systems and devices specifically designed for radial access are needed to enable more interventionalists to safely perform neurointerventional procedures via wrist access. [ABSTRACT FROM AUTHOR]

Introduction: Transradial access has become gold standard for percutaneous coronary catheterisation procedures. As the learning curve overcomes, safe alternative access sites such as Distal Radial Artery (DRA), ulnar artery have been tried. Aim: The aim of this study was to generate best evidence for using right DRA for coronary angiography. Materials and Methods: In this retrospective study, a novel route in addition to radial artery was studied. A total of 150 cases who underwent the angiogram by the DRA technique were included in the study, preserving the radial artery for various procedures. DRA was punctured in anatomical snuffbox by standard techniques and coronary angiography was performed. The evaluated parameters included the characteristics of patients (gender and age distribution), blood pressure (systolic and diastolic), mean arterial pressure, flouro time, puncture time, Dose Area Product (DAP) and cumulative air kerma. Fisher’s-exact test was used to find out the association between the gender, hypertension, diabetes and the success of puncture. Results: There was 93.4% successful puncture rate for distal radial access. There was no influence of age on the success of puncture. The association of success of puncture with gender, hypertension and diabetes was not statistically significant. Conclusion: This study presents that the distal radial approach is feasible and relatively safe. Further randomised controlled trials may be required to establish this relatively new approach as the standard care.

The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p

[Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Trans-Radial access has become gold standard for percutaneous coronary catheterisation procedures. As the learning curve overcomes, safe alternative access sites such as Distal Radial Artery (DRA), ulnar artery have been tried. Aim: The aim of this study was to generate best evidence for using right DRA for coronary angiography. Materials and Methods: In this retrospective study, a novel route in additional to radial artery was studied. A total of 150 cases who underwent the angiogram by the DRA technique were included in the study, preserving the radial artery for various procedures. DRA was punctured in anatomical snuffbox by standard techniques and coronary angiography was performed. The evaluated parameters included the characteristics of patients (gender and age distribution), blood pressure (systolic and diastolic), mean arterial pressure, flouro time, puncture time, Dose Area Product (DAP) and cumulative air kerma. Fischer-exact test was used to find out the association between the gender, hypertension, diabetes and the success of puncture. Results: There was 93.4% successful puncture rate for distal radial access. There was no influence of age on the success of puncture. The association of success of puncture with gender, hypertension and diabetes was not statistically significant. Conclusion: This study presents that the distal radial approach is feasible and relatively safe. Further randomised controlled trials may be required to establish this relatively new approach as the standard care. [ABSTRACT FROM AUTHOR]

Objective: Distal radial artery access or trans-snuffbox access (TSA) is a novel, safe, and feasible technique for coronary artery interventions wherein its vascular hemostasis is still concerned. So, this study aimed to compare two homeostasis methods comprising manual and mechanical compression approaches in patients undergoing coronary angiography (CAG) via TSA. Methods: In a prospective nonrandomized clinical trial, a total of 80 patients undergoing diagnostic CAG by TSA were divided into two equal groups: manual compression and mechanical compression (using radial TR band), the main end point of which was primary hemostasis time. Other variables were patient satisfaction, puncture site pain severity, hospitalization time, and local neurovascular complication during the 30-day follow-up. Results: The mean age of the patients was 57.1±8.0 years, with 40 of them (54.1%) being male. The primary hemostasis time was significantly shorter in the manual compression approach [15.0±5.9 minutes with median 15 (9-20)] than in the TR band group [25.7±4.9 minutes with median 25 (20-30)] (p<0.001). No significant difference was noted in the patient's satisfaction and puncture site pain severity as well as hospitalization time between the two methods (p>0.050). The neurovascular complication, including hematoma, numbness, and dRA occlusion, rates had also no significant difference between the two groups (p>0.050). Conclusion: The manual compression approach on the puncture site reduces hemostasis time in patients undergoing CAG via TSA when compared with the mechanical compression method. [ABSTRACT FROM AUTHOR]

The radial artery is the preferred access site for cardiac catheterization because of patient comfort, early ambulation, and improved survival in acute coronary syndromes, when compared to the femoral artery route. However, it is associated with a high radial artery occlusion (RAO) rate, and patent haemostasis which can reduce this is extremely hard to implement in a busy clinical practice. Smaller sized sheaths are associated with less RAO but are uncommonly used as they could limit procedural prowess and complexity. Alternatively, the distal radial artery (dRA) approach appears to be safer with observed RAO rates of well under 1 percent without compromising benefits offered by the radial artery access. Default dRA can be accessed by palpation alone in most cases with some practice, and this can be improved further with ultrasound guidance. There is a subset of patients, especially in the elderly, where dRA access can be particularly challenging. To mitigate this, we propose a two-step cannulation strategy and illustrate this with a few cases with difficult dRA and radial artery anatomies. [ABSTRACT FROM AUTHOR]

We report the first three cases in which the feasibility and safety of the left snuff box radial access in transcatheter arterial embolization (TAE) for unruptured renal angiomyolipoma (AML) were evaluated. Three patients with unruptured renal AMLs underwent TAE via the left snuff box radial artery. We retrospectively evaluated the characteristics of the AMLs, technical success rate, clinical success rate, and complications. Technical success and clinical success were defined as successful insertions of microballoon catheters selectively via the left distal radial artery into all intended arteries in a treatment session and shrinkage of tumor size as evaluated by CT or MRI after the procedure, respectively. The median size of the renal AMLs was 49 mm. TAE was successfully performed in all cases and all feeding arteries were successfully selected with a microballoon catheter through the left snuff box radial artery. The median amount of the mixture of ethanol and Lipiodol was 1.8 mL. Tumor shrinkage was confirmed in all with a median follow-up period of 6 months. The clinical success rate was 100%. No major complications occurred. The left snuff box access in TAE for an unruptured renal AML is safe and feasible. [ABSTRACT FROM AUTHOR]

Background: The standard approach for transarterial embolization of uterine fibroids or adenomas is via the femoral artery, but this approach limits the patient's quality of life and increases the risk of deep vein thrombosis in the lower extremities. We applied the distal radial approach technique for the treatment of uterine artery embolization, and aimed to explore the feasibility and safety of uterine artery chemoembolization through the distal radial approach., Methods: We conducted a retrospective study at The First Hospital of Jilin University from January 1, 2021 to November 30, 2023. The main inclusion criteria were: (I) uterine fibroids and adenomyosis were confirmed by preoperative imaging examination; (II) able to accurately palpate the distal radial artery pulse, and the Allen test is negative. Exclusion criteria: patients with distal radial pulses that cannot be palpated, or who are palpable but have radial arteriotomy dialysis, have a tortuous angle on preoperative radial artery ultrasound, which is not conducive to guidewire catheter passage. The primary endpoint of this study was the success rate of distal radial artery puncture. The secondary endpoints included complications and the duration of the puncture., Results: Sixteen patients were enrolled in this study, of which 8 (50%) had uterine fibroids, 5 (31.25%) had uterine adenomas, and 3 (18.75%) had both. The puncture success rate was 93.75% (15/16) and one patient who failed to puncture the distal radial artery was changed to the radial artery approach. The mean time of puncture was 21±8.54 minutes. There were no complications, including bleeding, hematoma, arterial dissection, pseudoaneurysm formation, or distal radial artery occlusion, observed., Conclusions: Uterine artery embolization by the distal radial artery approach is safe and feasible, and should be widely promoted in uterine artery embolization., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-118/coif). All authors report that this work was supported by Beijing Medical Award Foundation-Application of Distal Radial Artery Approach in Uterine Artery Embolization Funding Project (No. YXJL-2022-0080-0342). The authors have no other conflicts of interest to declare., (2024 Gland Surgery. All rights reserved.)

Background: The method of hemostasis for the distal radial approach has not been standardized, although this approach has become increasingly popular due to its advantages. In this study, we investigated the feasibility of manual compression hemostasis using a calcium alginate pad after coronary angiography via the distal radial approach., Methods: We retrospectively collected 150 consecutive patients (mean age, 74.9 ± 8.0 years; male, 75 %) who underwent coronary angiography via the distal radial artery with a predominantly 4 Fr sheath from April 2021 to December 2022 and were hemostatic according to the following methods. After sheath removal, hemostasis was achieved by manual compression for 10 min using a hemostatic pad containing calcium alginate. When hemostasis was confirmed, a small log-shaped gauze was placed over the pad and fixed using a self-adhesive elastic bandage for 2 h. All procedures were performed by four fellows just beginning the distal radial approach., Results: The mean compression time was 12.4 ± 4.8 min, and hemostasis was successfully achieved in all patients, allowing the release of the elastic bandage after 2 h, with only one patient oozing the next morning. There were no major complications, while one patient had a >10 cm hematoma. Compared to that of the first 15 patients, for each fellow, the compression time of the subsequent patients was significantly shorter (14.5 ± 6.7 vs 11.1 ± 2.1 min, p < 0.01)., Conclusions: Manual compression hemostasis using calcium alginate pads for the distal radial artery approach appears feasible with a simple learning., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)