Heparin-free distal radial artery approach to cardiac catheterisation and the small radial recurrent artery

Abstract

Aim: Our study aimed highlighting experience in reducing crossover rate from radial to femoral access to maintain coronary procedure safety and patients' satisfaction. Methods and results:A prospective, single center, single operator observational study included all comers for coronary procedures. The default access for coronary procedures was the right Radial artery, whenever failed, right Ulnar artery utilized then left Radial then left Ulnar "RURU". We studied 1000 procedures "964 patients" whom the default access was the radial artery. Radial access succeeded in 908 "90.8%" procedures and failed in 92 "9.2%" procedures necessitating crossover to other access site. One of the right ulnar, left radial or left ulnar succeeded in 51 out of 92 patients reducing the total crossover to femoral access to 4.1%. The remaining 41 procedures were obliged to crossover to femoral access. Radial artery spasm and vessel tortuosity were the commonest causes of crossover from radial to RURU/femoral artery "p=0.012 and 0.0017 respectively". Minor hematomas were the commonest immediate complication "p<0.022" with non significant prolongation of procedural time and radiation exposure. Conclusion:RURU approach has resulted in significant crossover rate reduction from radial to femoral access maintaining procedural safety and patient's satisfaction on expense of increased minor hematomas and non-significant increase of procedural time and radiation exposure.

Non-traumatic parasternal pericardiocentesis

“…Slender techniques are generally non-traumatic. 5 This two-step technique was previously described elsewhere and it allows accessing the pericardial space at a first pass in a fully anticoagulated patient. 6 This additional step potentially renders the procedure as safe as a diagnostic pleural tap.…”