From the Guidelines
Distal radial access is preferred over traditional radial access for certain interventional procedures due to its advantages in patient comfort, reduced risk of radial artery occlusion, and potentially lower complication rates. The choice between distal radial access (DRA) and traditional radial access should be based on individual patient needs and operator expertise. DRA involves accessing the radial artery in the anatomical snuffbox or the dorsum of the hand, which can provide a more natural arm position and reduce the risk of complications such as hematoma formation 1.
The primary advantages of DRA include:
- Increased patient comfort due to less hyperextension required
- Reduced risk of radial artery occlusion at the conventional site, preserving it for future procedures
- Potentially lower rates of complications such as hematoma formation
- Preservation of the proximal radial artery for potential future arterial grafts
According to the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline, the radial artery has become the preferred vascular access site for patients undergoing cardiac catheterization and PCI, with lower mortality, bleeding, and vascular complications compared to femoral access 1. While traditional radial access is well-established, DRA offers a viable alternative with its own set of benefits, particularly for patients requiring repeat procedures or those with previous traditional radial access complications.
However, DRA may be more technically challenging to perform, especially for operators with limited experience, and may not be suitable for all patients, particularly those with small or calcified distal radial arteries. The procedure typically requires a 5-6 Fr sheath and standard catheterization tools, with local anesthesia and vasodilators used to prevent vasospasm. Ultimately, the choice between DRA and traditional radial access should be made on a case-by-case basis, considering the individual patient's needs and the operator's expertise.
From the Research
Indications and Advantages of Distal Radial Access
- Distal radial access is a relatively new approach that involves accessing the radial artery at a more distal location, typically near the wrist [@\5@].
- The indications for distal radial access are similar to those for traditional radial access, including coronary angiography, percutaneous coronary intervention, and other cardiac procedures [@\2@, @\3@].
- The advantages of distal radial access include reduced risk of radial artery occlusion, decreased risk of bleeding complications, and improved patient comfort [@\4@, @\5@].
Comparison with Traditional Radial Access
- Traditional radial access involves accessing the radial artery at a more proximal location, typically near the elbow [@\1@, @\2@].
- Distal radial access has been shown to have a lower risk of radial artery spasm and occlusion compared to traditional radial access [@\3@, @\5@].
- However, the choice between distal and traditional radial access ultimately depends on the individual patient's anatomy and the operator's preference [@\2@, @\4@].
Prevention of Radial Artery Spasm
- Radial artery spasm is a common complication of radial access, and can be prevented using various techniques, including the administration of intra-arterial vasodilators such as verapamil, nitroglycerin, and nicardipine [@\2@, @\3@, @\4@].
- The use of subcutaneous nitroglycerin has been shown to be effective in preventing radial artery spasm and occlusion [@\5@].
- The choice of vasodilator and route of administration depends on the individual patient's needs and the operator's preference [@\2@, @\3@, @\4@].