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Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis
Objectives This study investigated the feasibility, safety, and the potential benefit of faster hemostasis with the distal transradial artery access (TRA). Background TRA has been shown to be associated with lower bleeding and vascular complications. Limited data are available regarding the new tech...
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Published in: | Catheterization and cardiovascular interventions 2019-11, Vol.94 (5), p.651-657 |
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creator | Aoi, Shunsuke Htun, Wah Wah Freeo, Stephanie Lee, Samuel Kyaw, Htoo Alfaro, Victor Coppola, John Pancholy, Samir Kwan, Tak |
description | Objectives
This study investigated the feasibility, safety, and the potential benefit of faster hemostasis with the distal transradial artery access (TRA).
Background
TRA has been shown to be associated with lower bleeding and vascular complications. Limited data are available regarding the new technique of accessing the distal radial artery in the anatomical snuffbox.
Methods
We retrospectively reviewed 202 consecutive patients who underwent coronary angiography and intervention with distal TRA. Two hundred and six conventional TRA cases were collected as a comparison arm.
Results
Out of 408 patients, successful distal radial access was obtained in 99.5% (201/202) in the distal TRA cases and 99.0% (204/206) in the conventional TRA cases. The rate of access site crossover was 2.0% (4/202) for distal TRA. Right distal radial artery was accessed in 176 cases (87.6%). Mean access time from local anesthesia to radial flush was 7.3 min. Ninety cases (44.8%) were percutaneous coronary interventions (PCIs) and the mean heparin dose used was 4,448 units (6,009 units for PCI and 3,182 units for diagnostic catheterization). Mean time to remove TR band was 104.7 min (120.8 min for PCI and 91.7 min for diagnostics). Follow‐up ultrasound study showed two partial occlusions (1.0%) and one arteriovenous fistula (0.5%) that resolved with prolonged TR band inflation.
Conclusions
Despite longer time to access the distal radial artery in the anatomical snuffbox, it is a safe and feasible alternative to conventional TRA and might result in shorter time to hemostasis especially in cases of PCI. |
doi_str_mv | 10.1002/ccd.28155 |
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This study investigated the feasibility, safety, and the potential benefit of faster hemostasis with the distal transradial artery access (TRA).
Background
TRA has been shown to be associated with lower bleeding and vascular complications. Limited data are available regarding the new technique of accessing the distal radial artery in the anatomical snuffbox.
Methods
We retrospectively reviewed 202 consecutive patients who underwent coronary angiography and intervention with distal TRA. Two hundred and six conventional TRA cases were collected as a comparison arm.
Results
Out of 408 patients, successful distal radial access was obtained in 99.5% (201/202) in the distal TRA cases and 99.0% (204/206) in the conventional TRA cases. The rate of access site crossover was 2.0% (4/202) for distal TRA. Right distal radial artery was accessed in 176 cases (87.6%). Mean access time from local anesthesia to radial flush was 7.3 min. Ninety cases (44.8%) were percutaneous coronary interventions (PCIs) and the mean heparin dose used was 4,448 units (6,009 units for PCI and 3,182 units for diagnostic catheterization). Mean time to remove TR band was 104.7 min (120.8 min for PCI and 91.7 min for diagnostics). Follow‐up ultrasound study showed two partial occlusions (1.0%) and one arteriovenous fistula (0.5%) that resolved with prolonged TR band inflation.
Conclusions
Despite longer time to access the distal radial artery in the anatomical snuffbox, it is a safe and feasible alternative to conventional TRA and might result in shorter time to hemostasis especially in cases of PCI.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.28155</identifier><identifier>PMID: 30801939</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Access time ; anatomical snuffbox ; Anesthesia ; Angiography ; Catheterization ; Complications ; distal transradial artery access ; Feasibility studies ; Fistulae ; Hemostasis ; Hemostatics ; Heparin ; Medical imaging ; Ultrasound ; vascular access ; Venous access</subject><ispartof>Catheterization and cardiovascular interventions, 2019-11, Vol.94 (5), p.651-657</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-5a6d40812b7522fcb3c6eadac85561e37df91ec86f1863f5af67f2a6e7dc43e03</citedby><cites>FETCH-LOGICAL-c3535-5a6d40812b7522fcb3c6eadac85561e37df91ec86f1863f5af67f2a6e7dc43e03</cites><orcidid>0000-0003-2689-7250 ; 0000-0001-7831-0699 ; 0000-0002-0659-9291 ; 0000-0002-3900-2463</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30801939$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aoi, Shunsuke</creatorcontrib><creatorcontrib>Htun, Wah Wah</creatorcontrib><creatorcontrib>Freeo, Stephanie</creatorcontrib><creatorcontrib>Lee, Samuel</creatorcontrib><creatorcontrib>Kyaw, Htoo</creatorcontrib><creatorcontrib>Alfaro, Victor</creatorcontrib><creatorcontrib>Coppola, John</creatorcontrib><creatorcontrib>Pancholy, Samir</creatorcontrib><creatorcontrib>Kwan, Tak</creatorcontrib><title>Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Objectives
This study investigated the feasibility, safety, and the potential benefit of faster hemostasis with the distal transradial artery access (TRA).
Background
TRA has been shown to be associated with lower bleeding and vascular complications. Limited data are available regarding the new technique of accessing the distal radial artery in the anatomical snuffbox.
Methods
We retrospectively reviewed 202 consecutive patients who underwent coronary angiography and intervention with distal TRA. Two hundred and six conventional TRA cases were collected as a comparison arm.
Results
Out of 408 patients, successful distal radial access was obtained in 99.5% (201/202) in the distal TRA cases and 99.0% (204/206) in the conventional TRA cases. The rate of access site crossover was 2.0% (4/202) for distal TRA. Right distal radial artery was accessed in 176 cases (87.6%). Mean access time from local anesthesia to radial flush was 7.3 min. Ninety cases (44.8%) were percutaneous coronary interventions (PCIs) and the mean heparin dose used was 4,448 units (6,009 units for PCI and 3,182 units for diagnostic catheterization). Mean time to remove TR band was 104.7 min (120.8 min for PCI and 91.7 min for diagnostics). Follow‐up ultrasound study showed two partial occlusions (1.0%) and one arteriovenous fistula (0.5%) that resolved with prolonged TR band inflation.
Conclusions
Despite longer time to access the distal radial artery in the anatomical snuffbox, it is a safe and feasible alternative to conventional TRA and might result in shorter time to hemostasis especially in cases of PCI.</description><subject>Access time</subject><subject>anatomical snuffbox</subject><subject>Anesthesia</subject><subject>Angiography</subject><subject>Catheterization</subject><subject>Complications</subject><subject>distal transradial artery access</subject><subject>Feasibility studies</subject><subject>Fistulae</subject><subject>Hemostasis</subject><subject>Hemostatics</subject><subject>Heparin</subject><subject>Medical imaging</subject><subject>Ultrasound</subject><subject>vascular access</subject><subject>Venous access</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kc9u1DAQxi0EoqVw4AWQJS70sK3_xI59RFsKSJW4gMQtmnXGXVdJvHiSQt-Ax8btbjkgcfJnzW--0czH2GspzqQQ6jyE_kw5acwTdiyNUqtW2e9PD1r6xh6xF0Q3QghvlX_OjrRwQnrtj9nvi0QzDHwuMFGBPlUNZcZyxyEEJOJp4vMWOUww5zGFWqdpiXGTf_GYCw-55Anu8ek65esCu23VVL8chupT29ItPppRmvGhLQLVIt_imOt8SvSSPYswEL46vCfs2-WHr-tPq6svHz-v31-tgjbarAzYvhFOqk1bl4tho4NF6CE4Y6xE3fbRSwzORumsjgaibaMCi20fGo1Cn7B3e99dyT8WpLkbEwUcBpgwL9Qp6YxrG-9NRd_-g97kpS40VEpL4euVXVOp0z0VSiYqGLtdSWO9SCdFdx9PV-PpHuKp7JuD47IZsf9LPuZRgfM98DMNePd_p269vthb_gGsOJvo</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Aoi, Shunsuke</creator><creator>Htun, Wah Wah</creator><creator>Freeo, Stephanie</creator><creator>Lee, Samuel</creator><creator>Kyaw, Htoo</creator><creator>Alfaro, Victor</creator><creator>Coppola, John</creator><creator>Pancholy, Samir</creator><creator>Kwan, Tak</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2689-7250</orcidid><orcidid>https://orcid.org/0000-0001-7831-0699</orcidid><orcidid>https://orcid.org/0000-0002-0659-9291</orcidid><orcidid>https://orcid.org/0000-0002-3900-2463</orcidid></search><sort><creationdate>20191101</creationdate><title>Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis</title><author>Aoi, Shunsuke ; Htun, Wah Wah ; Freeo, Stephanie ; Lee, Samuel ; Kyaw, Htoo ; Alfaro, Victor ; Coppola, John ; Pancholy, Samir ; Kwan, Tak</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-5a6d40812b7522fcb3c6eadac85561e37df91ec86f1863f5af67f2a6e7dc43e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Access time</topic><topic>anatomical snuffbox</topic><topic>Anesthesia</topic><topic>Angiography</topic><topic>Catheterization</topic><topic>Complications</topic><topic>distal transradial artery access</topic><topic>Feasibility studies</topic><topic>Fistulae</topic><topic>Hemostasis</topic><topic>Hemostatics</topic><topic>Heparin</topic><topic>Medical imaging</topic><topic>Ultrasound</topic><topic>vascular access</topic><topic>Venous access</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aoi, Shunsuke</creatorcontrib><creatorcontrib>Htun, Wah Wah</creatorcontrib><creatorcontrib>Freeo, Stephanie</creatorcontrib><creatorcontrib>Lee, Samuel</creatorcontrib><creatorcontrib>Kyaw, Htoo</creatorcontrib><creatorcontrib>Alfaro, Victor</creatorcontrib><creatorcontrib>Coppola, John</creatorcontrib><creatorcontrib>Pancholy, Samir</creatorcontrib><creatorcontrib>Kwan, Tak</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aoi, Shunsuke</au><au>Htun, Wah Wah</au><au>Freeo, Stephanie</au><au>Lee, Samuel</au><au>Kyaw, Htoo</au><au>Alfaro, Victor</au><au>Coppola, John</au><au>Pancholy, Samir</au><au>Kwan, Tak</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>94</volume><issue>5</issue><spage>651</spage><epage>657</epage><pages>651-657</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objectives
This study investigated the feasibility, safety, and the potential benefit of faster hemostasis with the distal transradial artery access (TRA).
Background
TRA has been shown to be associated with lower bleeding and vascular complications. Limited data are available regarding the new technique of accessing the distal radial artery in the anatomical snuffbox.
Methods
We retrospectively reviewed 202 consecutive patients who underwent coronary angiography and intervention with distal TRA. Two hundred and six conventional TRA cases were collected as a comparison arm.
Results
Out of 408 patients, successful distal radial access was obtained in 99.5% (201/202) in the distal TRA cases and 99.0% (204/206) in the conventional TRA cases. The rate of access site crossover was 2.0% (4/202) for distal TRA. Right distal radial artery was accessed in 176 cases (87.6%). Mean access time from local anesthesia to radial flush was 7.3 min. Ninety cases (44.8%) were percutaneous coronary interventions (PCIs) and the mean heparin dose used was 4,448 units (6,009 units for PCI and 3,182 units for diagnostic catheterization). Mean time to remove TR band was 104.7 min (120.8 min for PCI and 91.7 min for diagnostics). Follow‐up ultrasound study showed two partial occlusions (1.0%) and one arteriovenous fistula (0.5%) that resolved with prolonged TR band inflation.
Conclusions
Despite longer time to access the distal radial artery in the anatomical snuffbox, it is a safe and feasible alternative to conventional TRA and might result in shorter time to hemostasis especially in cases of PCI.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>30801939</pmid><doi>10.1002/ccd.28155</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-2689-7250</orcidid><orcidid>https://orcid.org/0000-0001-7831-0699</orcidid><orcidid>https://orcid.org/0000-0002-0659-9291</orcidid><orcidid>https://orcid.org/0000-0002-3900-2463</orcidid></addata></record> |
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subjects | Access time anatomical snuffbox Anesthesia Angiography Catheterization Complications distal transradial artery access Feasibility studies Fistulae Hemostasis Hemostatics Heparin Medical imaging Ultrasound vascular access Venous access |
title | Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis |
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