ROUTINE ULTRASOUND USE IN CONSECUTIVE PATIENTS CATHETERIZED VIA DISTAL RADIAL ACCESS

Distal radial access (DRA) in cardiac catheterizations is alternative to conventional radial access (cTRA). It has distinct advantages over cTRA. Among other substantial reduction of radial artery occlusion. However puncture is more laborious with higher crossover rate and takes more puncture attempts. Patients w/o palpable DRA are deemed to be ineligible for DRA puncture. Prevalence of those patients in population iremains unknown. Ultrasound (US) is widely recognized as useful tool to gain vascular access. However among inteventionalists using radial access is from various reasons grossly underused.
To estimate proportion of patients not feasible for DRA cannulation we included in our project consecutive patients irrespective of DRA palpation presence. All punctures were performed with US in order to perform cannulation also in subjects w/o palpable DRA
RESULTS: We have evaluated 100 consecutive stable patients scheduled for cardiac catheterization irrespective of absence or presence of DRA pulsation and performed US guided puncture. We have collected data about DRA diameter, success rate and other standard demographic and procedural data.
Overall success rate of sheath insertion was 94%. Proportion of subject w/o palpable DRA was 11%. Notably, in those patients with US guidance were 9 successful sheath insertions (84%). Mean puncture attempts were 1,8 and median 1.
Rate of DRA w/o palpable pulsation is non selected population around 10%. Using systematic US guidance can be successful arterial sheath insertion achieved in approximately 80% of such patients.

CONCLUSION: Overall success rate (≥90%) in nonselected population is high enough to support hypothesis, that DRA can became primary access site. Systematic US guidance for DRA puncture is clinically feasible and allows to gain arterial access in patients where palpation method inherently fails.