Distal accesses in the hand (two novel techniques) for percutaneous coronary angiography and intervention

Farshad Roghani-Dehkordi, Omid Hashemifard, Masoumeh Sadeghi, Rohollah Mansouri, Mehdi Akbarzadeh, Asieh Dehghani, Mojtaba Akbari, Farshad Roghani-Dehkordi, Omid Hashemifard, Masoumeh Sadeghi, Rohollah Mansouri, Mehdi Akbarzadeh, Asieh Dehghani, Mojtaba Akbari

Abstract

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.

Keywords: Coronary Angiography; Coronary Angioplasty; Distal Accesses; Novel Accesses; Trans-Palmar Approach; Trans-Snuff Box Approach.

Figures

Figure 1
Figure 1
Snuff box artery is deep palmar branch of radial artery and palmar artery is superficial palmar branch of ulnar artery. The figure shows their schematic organization and their radiography.
Figure 2
Figure 2
The first successful coronary angiography preformed on deep palmar branch of radial artery in a 65-year-old man in 1 October 2016.
Figure 3
Figure 3
The first successful coronary angiography preformed on right superficial palmar branch of ulnar artery in a 64-year-old man in 15 October 2016.

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Source: PubMed

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