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

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 ۲۳۵ patients, and trans-palmar access (superficial palmar branch of ulnar artery) on ۱۷۵ patients in ۳ hospitals in Isfahan City, Iran.RESULTS: In ۲۲۱ patients out of ۲۳۵ ones (۹۴.۱%) [men: ۷۶.۵%, age: ۵۷.۴ ± ۱۰.۴ (years); women: ۲۳.۵%, age: ۶۲.۴ ± ۹.۵ (years)], our procedure through snuff box (dorsal hand) was successfully performed. In ۱۵۹ patients out of ۱۷۵ ones (۹۰.۸%) [men: ۷۶.۰%, age: ۵۸.۱ ± ۱۰.۵ (years); women: ۲۴.۰%, age: ۶۱.۲ ± ۹.۶ (years)], our procedure through palmar artery was successfully performed. In total, the evaluated patients had mild pain (۳.۴% for snuff box, and ۴.۵% for palmar), ecchymosis in distal forearm (۵.۱% for snuff box, and ۲.۸% 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 ۲۸.۹% and ۱۸.۲% 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 ۳-۱۵ 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 , Trans-Palmar Approach , Trans-Snuff Box Approach , Distal Accesses , Novel Accesses