Document Type : Case Series
- Farshad Roghani-Dehkordi 1
- Omid Hashemifard 2
- Masoumeh Sadeghi 3
- Rohollah Mansouri 4
- Mehdi Akbarzadeh 5
- Asieh Dehghani 6
- Mojtaba Akbari 7
1 Associate Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Cardiologist, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
6 School of Nursing and Midwifery AND Young Researchers and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
7 Department of Biostatistics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: Trans-radial and trans-ulnar accesses have been practiced and recommended as default and alternative techniques for coronary angiography and angioplasty in recent years. In this study, we present new innovative approaches using more distal access points, i.e. trans-snuff box and trans-palmar approaches.METHODS: We conducted dorsal hand access (trans-snuff box) for angiography and/or angioplasty on 235 patients, and trans-palmar access (superficial palmar branch of ulnar artery) on 175 patients in 3 hospitals in Isfahan City, Iran.RESULTS: In 221 patients out of 235 ones (94.1%) [men: 76.5%, age: 57.4 ± 10.4 (years); women: 23.5%, age: 62.4 ± 9.5 (years)], our procedure through snuff box (dorsal hand) was successfully performed. In 159 patients out of 175 ones (90.8%) [men: 76.0%, age: 58.1 ± 10.5 (years); women: 24.0%, age: 61.2 ± 9.6 (years)], our procedure through palmar artery was successfully performed. In total, the evaluated patients had mild pain (3.4% for snuff box, and 4.5% for palmar), ecchymosis in distal forearm (5.1% for snuff box, and 2.8% for palmar), with no major complications even one (amputation, infection, thrombosis, need for surgery, hand dysfunction, nerve palsy, and so forth). In addition, percutaneous coronary intervention (PCI) was done in 28.9% and 18.2% of cases via snuff box and palmar approaches, respectively. Meanwhile, hemostasis was very fast and easy with discharge time equivalent to other upper limb accesses.CONCLUSION: Although our procedures are at their early stages with about a follow-up period of 3-15 months, more researches are recommended to be conducted in forthcoming months and years, and this new innovative approaches could be suggested safe, feasible, and reliable with low complications.
- Liu J, Fu XH, Xue L, Wu WL, Gu XS, Li SQ. A comparative study of transulnar and transradial artery access for percutaneous coronary intervention in patients with acute coronary syndrome. J Interv Cardiol 2014; 27(5): 525-30.
- Sallam M, Al-Riyami A, Misbah M, Al-Sukaiti R, Al-Alawi A, Al-Wahaibi A. Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience. J Saudi Heart Assoc 2014; 26(3): 138-44.
- Kiemeneij F. Left distal transradial access in the
- anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI). EuroIntervention 2017; 13(7): 851-7.
- Roghani F, Shirani B, Hashemifard O. The effect of low dose versus standard dose of arterial heparin on vascular complications following transradial coronary angiography: Randomized controlled clinical trial. ARYA Atheroscler 2016; 12(1): 10-7.
- Costa F, van Leeuwen MA, Daemen J, Diletti R, Kauer F, van Geuns RJ, et al. The rotterdam radial access research: Ultrasound-based radial artery evaluation for diagnostic and therapeutic coronary procedures. Circ Cardiovasc Interv 2016; 9(2): e003129.
- Kumar AJ, Jones LE, Kollmeyer KR, Feldtman RW, Ferrara CA, Moe MN, et al. Radial artery access for peripheral endovascular procedures. J Vasc Surg 2017; 66(3): 820-5.
- Maniotis C, Koutouzis M, Andreou C, Lazaris E, Tsiafoutis I, Zografos T, et al. Transradial approach for cardiac catheterization in patients with negative Allen's test. J Invasive Cardiol 2015; 27(9): 416-20.
- Rao SV, Kedev S. Approaching the post-femoral era for coronary angiography and intervention. JACC Cardiovasc Interv 2015; 8(4): 524-6.
- Roghani-Dehkordi F, Hadizadeh M, Hadizadeh F. Percutaneous trans-ulnar artery approach for coronary angiography and angioplasty; A case series study. ARYA Atheroscler 2015; 11(5): 305-9.
- Roghani F, Tajik MN, Khosravi A. Compare complication of classic versus patent hemostasis in transradial coronary angiography. Adv Biomed Res 2017; 6: 159.
- Valsecchi O, Vassileva A, Musumeci G, Rossini R, Tespili M, Guagliumi G, et al. Failure of transradial approach during coronary interventions: Anatomic considerations. Catheter Cardiovasc Interv 2006; 67(6): 870-8.
- Dehghani P, Mohammad A, Bajaj R, Hong T, Suen CM, Sharieff W, et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv 2009; 2(11): 1057-64.
- Biondi-Zoccai G, Sciahbasi A, Bodi V, Fernandez- Portales J, Kanei Y, Romagnoli E, et al. Right
- versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients. Int J Cardiol 2013; 166(3): 621-6.
- Dahal K, Rijal J, Lee J, Korr KS, Azrin M. Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 2016; 87(5): 857-65.
- Gokhroo R, Kishor K, Ranwa B, Bisht D, Gupta S, Padmanabhan D, et al. Ulnar artery interventions non-inferior to radial approach: Ajmer ulnar artery (AJULAR) intervention working group study results. J Invasive Cardiol 2016; 28(1): 1-8.
- Roghani-Dehkordi F. Merits of more distal accesses in the hand for coronary angiography and intervention. Proceedings of the 4th International Cardiovascular Joint Congress in Isfahan; 2016 Nov. 24-25; Isfahan, Iran.
- Kaledin A, Kochanov I, Podmetin P, Ardeev VN. Distal radial artery in endovascular interventions [Online]. [cited 2017]; Available from: URL:
- Babunashvili A. Novel snuff-box technique for trans-radial approach: Let’s go distal. Proceedings of the Aim-Radial 2016; 2016 Sep. 23-22; Budapest, Hungary.
- Latsios G, Toutouzas K, Synetos A, Vogiatzi G, Papanikolaou A, Tsiamis E, et al. Left distal radial artery for cardiac catheterization: Insights from our first experience. Hellenic J Cardiol 2018.
- McNamara MG, Butler TE, Sanders WE, Pederson WC. Ischaemia of the index finger and thumb secondary to thrombosis of the radial artery in the anatomical snuffbox. J Hand Surg Br 1998; 23(1): 28-32.