IMR Press / RCM / Volume 23 / Issue 10 / DOI: 10.31083/j.rcm2310331
Open Access Review
Arterial Accesses in Coronary Angiography and Intervention—Review with a Focus on Prognostic Relevance
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1 Kardiologisch-Angiologische Praxis ● Herzzentrum Bremen, Senator-Weßling-Str 1a, 28277 Bremen, Germany
2 Klinik für Innere Medizin und Kardiologie, Hospital zum Heiligen Geist, Akademisches Lehrkrankenhaus der Universität Düsseldorf, Von-Broichhausen-Allee 1, 47906 Kempen, Germany
*Correspondence: (Christoph Langer)
Academic Editor: Arnold Seto
Rev. Cardiovasc. Med. 2022, 23(10), 331;
Submitted: 11 July 2022 | Revised: 23 August 2022 | Accepted: 24 August 2022 | Published: 28 September 2022
(This article belongs to the Special Issue Optimal vascular access techniques for patient safety and efficiency)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Arterial access in coronary angiography has always been an important issue. Convincing prognostic data from large randomized controlled trials (RCTs) in the first place but also safe performance of same-day-discharge after diagnostic and interventional procedures, improved patient comfort and cost-effectiveness led to a paradigm shift from the transfemoral approach (TFA) to the transradial approach (TRA) in several clinical situations. Consequently, today’s relevant guidelines recommend a radial-first strategy as default approach. However, there is still strong controversy among interventional cardiologists resulting in delayed spread of the TRA causing significant regional differences. One major critics point is the rate of postprocedural radial artery occlusion (RAO) after using the traditional puncture site at the proximal radial artery (pTRA) which was registered too high in certain centers. A new access using the distal radial artery (dTRA) in the area of the snuff box (SB) and the dorsal box (DB) has been proven to minimize RAO and enabling even complex interventions using 7F guiding catheters. Although, dTRA seems to be an advantageous option, this approach is still not widely used. This review—addressed to beginners and even advanced interventionalists—presents all arterial access routes in interventional cardiology. It focusses on those to be routinely preferred and also on the possibility to guide the puncture with ultrasound. Thereby, the various approaches, including the transulnar (TRU) but also the still relevant TFA approach, are discussed in detail. Thereby, we introduce our philosophy of “radial freedom” and a new classification for TRA.

snuff box
dorsal box
radial freedom
Fig. 1.
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