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A systematic review of the main approaches to catheterization/ coronary angioplasty by a distal radial artery in the anatomical snuffbox

Otavio Queiroz Assumpcao, Vanessa Piovesan Freitas Assumpcao, Pedro Wagner Ramos Junior, Marcos Eduardo dos Santos Dotto, Francisco Correa de Almeida Moraes, Antonio Carlos Broim Pancotti, Caio Fraga Barreto de Matos Ferreira, Jaquelini Tirapelle Ayub Ribeiro, Monique Souza Bandoli Franca, Viviane Ferreira Gali, Idiberto Jose Zotarelli Filho, Luiz Antonio Gubolino

Introduction: In the scenario of cardiovascular disease (CVD), the WHO reported in 2017 that there are about 21.7 million deaths, of which more than ten million are due to atherosclerotic coronary disease. In Brazil, CVD are responsible for about 384 thousand deaths per year. Arterial access for coronary angiography and percutaneous coronary interventions has addressed the change from the transfemoral to the transradial (TRA) pathway, as this presents fewer complications, especially the distal transradial pathway (dTRA) in the anatomical snuffbox. Objective: To carry out a systematic review of the main snuffbox approaches. Methods: Review papers, systematic reviews, prospective studies, retrospective studies, clinical trials, and case reports were selected. The MeSH Terms were the Radial artery, Catheterization, Percutaneous coronary intervention. Of the total of 105 articles found, 23 studies were selected, following the rules of PRISMA.

Results: The studies analyzed showed that dTRA is a reliable, safe, effective and comfortable route. The position of the arm during the intervention is comfortable for the patient, who does not need to expose the palm side of the arm while flexing the arm towards the operator. The studies also reported that there is a low rate of obstruction of the distal radial artery. There is also early hemostasis, low risk of hematoma formation, low level of pain perceived by patients, reduced risk of compartment syndrome, saving the radial artery for possible future myocardial revascularization grafting, and the operator's ability to work at a safe distance of the radiation source. The average success rate in the studies analyzed was 97%. The average rate of occlusion of the distal radial artery was 0.5%. Other complications at the access site were hematoma (0.2%), pulsatile hematoma (<0.1%), infection (0.1%), dissection (0.1%), arteriovenous fistula (<0.1%). Conclusion: Distal radial access is a reliable, safe, effective, and comfortable route for cardiovascular interventions. They have a less arterial obstruction and short hemostasis. The main disadvantage is the difficulty in cannulation. However, more randomized studies and meta-analysis are needed to establish a guideline.