Background Several studies have recently reported regarding feasibility and safety of distal transradial access (d-TRA) in the anatomical snuff-box (ASB); however, literature comparing it with the conventional TRA at the wrist (w-TRA) is sparse. This study compares the technical efficiency and safety of ASB and wrist approaches for TRA for coronary angiography (CAG) and evaluates the radial artery (RA) anatomy at these sites. Methods Two hundred consecutive patients undergoing CAG via w-TRA or d-TRA (100 in each group) were investigated. The primary endpoint was comparison of procedural efficiency of the two methods, defined as CAG completion from the intended access site. The secondary endpoints assessed d-TRA approach in terms of achievement of successful cannulation, arterial puncture, access time (AT), and total procedure time (TPT) in comparison with the conventional method. Safety endpoints included radiation parameters and complications. Furthermore, in 112 normal adults, RA anatomy was assessed at wrist and at ASB. Results In d-TRA group, 77% patients achieved primary endpoint compared with 93% in w-TRA group ( p = 0.004). The success of arterial puncture was comparable for d-TRA and w-TRA (93% and 99%, respectively; p = 0.065), but the cannulation rate was lower for d-TRA. Safety endpoints were similar in both the groups. AT and TPT were longer for d-TRA. Conclusions The ASB approach for CAG lowers the success rate and prolongs AT and TPT. The RA at ASB is smaller, has a curved course, and more anatomical variations than the RA at the wrist.

Background: Several studies have recently reported regarding feasibility and safety of distal transradial access (d-TRA) in the anatomical snuff-box (ASB); however, literature comparing it with the conventional TRA at the wrist (w-TRA) is sparse. This study compares the technical efficiency and safety of ASB and wrist approaches for TRA for coronary angiography (CAG) and evaluates the radial artery (RA) anatomy at these sites. Methods: Two hundred consecutive patients undergoing CAG via w-TRA or d-TRA (100 in each group) were investigated. The primary endpoint was comparison of procedural efficiency of the two methods, defined as CAG completion from the intended access site. The secondary endpoints assessed d-TRA approach in terms of achievement of successful cannulation, arterial puncture, access time (AT), and total procedure time (TPT) in comparison with the conventional method. Safety endpoints included radiation parameters and complications. Furthermore, in 112 normal adults, RA anatomy was assessed at wrist and at ASB. Results: In d-TRA group, 77% patients achieved primary endpoint compared with 93% in w-TRA group (p ¼ 0.004). The success of arterial puncture was comparable for d-TRA and w-TRA (93% and 99%, respectively; p ¼ 0.065), but the cannulation rate was lower for d-TRA. Safety endpoints were similar in both the groups. AT and TPT were longer for d-TRA. Conclusions: The ASB approach for CAG lowers the success rate and prolongs AT and TPT. The RA at ASB is smaller, has a curved course, and more anatomical variations than the RA at the wrist.

We report here a rare case of dabigatran-related spontaneous cardiac tamponade, which appeared in absence of the known risk factors that predispose the patient to bleed related to anticoagulant drugs. A 65-year-old lady presented to the emergency room with sudden onset dyspnea which woke her up in the early morning hours. Four days earlier, she had been started on dabigatran therapy for DVT. On examination, she was in shock. Transthoracic echocardiography confirmed cardiac tamponade. Emergent pericardiocentesis was done, draining 480 ml of haemorrhagic fluid, which tested negative for microbes and malignant cells. The patient recovered rapidly and fluid did not re-accumulate after withdrawal of dabigatran therapy. Spontaneous cardiac tamponade is rare with the use of direct anticoagulants, especially dabigatran, in the absence of predisposing risk factors. This case study highlights the need for clinicians to be cognizant of this potentially life-threatening adverse drug reaction of dabigatran so that appropriate timely action can be taken toward diagnosis and management of this complication.