Novel distal radial access for cardiac catheterization shown as a safe strategy compared to conventional radial access (Fewer complications than normal approach)

Medical Xpress / Society for Cardiovascular Angiography & Interventions (SCAI) 2022 ^ | May 19, 2022 | Karim Al-Azizi, MD, FSCAI

[ConservativeMind]

Initial findings from the Distal versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention (DIPRA) study were presented today. The single center, randomized-controlled trial evaluated outcomes of hand function and effectiveness of conventional proximal radial artery (PRA) access compared to distal radial artery (DRA) access for cardiac catheterization.

Current guidelines for patients undergoing percutaneous intervention recommend PRA access. A complication of PRA is radial artery occlusion, or a blocking of the vessel, which can compromise the access of artery for future coronary bypass surgery, dialysis or other cardiovascular procedures. DRA has the potential to preserve the radial access but little is known of the potential detrimental effects on hand function due to the close proximity to the radial nerve.

In the DIPRA study 300 patients were randomized 1:1 to undergo cardiac catheterization through the DRA or PRA. The primary endpoint was change in hand function from baseline at 30 days and one year. Hand function was a composite of the QuickDASH questionnaire, hand grip test and pinch test. Secondary endpoints included access feasibility, radial artery patency and complications.

Of the 251 patients who completed their 30 day follow up,126 were randomized to DRA and 125 to PRA. Both groups had similar rates of access site bleeding. Radial artery occlusion occurred in two patients in the PRA vs none in the DRA. There was no significant difference in the change of hand function. There was no significant difference in the composite of hand function between PRA and DRA.

"Recently, we've seen growing interest in the distal artery as a unique access for cardiac catheterization," said Karim Al-Azizi, MD, FSCAI. "This study serves as reassurance for physicians that should we choose distal radial access over proximal access, it is safe at 30 days and provides minimal risk to hand function."

[ConservativeMind]

If you are going in for this common procedure, suggest to your surgeon you’d like him or her to use the distal radial artery, and provide this study.

[ConservativeMind]

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[catnipman]

“A complication of PRA is radial artery occlusion, or a blocking of the vessel, which can compromise the access of artery for future coronary bypass surgery, dialysis or other cardiovascular procedures.”

this is EXACTLY what happened to me!

[ConservativeMind]

How does this affect you, day to day, now? It sounds like some bad damage occurred.

[catnipman]

“How does this affect you, day to day, now? It sounds like some bad damage occurred.”

fortunately, i possess the anatomical structure called the palmar arch, which connects the radial artery and the ulnar artery at the wrist, so circulation to the hand can still take place via the ulnar artery even if the radial artery is occluded ... most people, but not everyone, possess the palmar arch ...

some studies estimate occlusion of the radial artery as high as 38% as a consequence of radial artery cardiac catheterization ... my advice is to always have cardiac catheterization done via the femoral artery ...

[sauropod]

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