The tabatière anatomique

Coronary angiography using the left distal radial approach - An alternative site to conventional radial coronary angiography

Objective:

To share our experience with the left distal radial approach for transradial coronary angiography and interventions. By performing the radial puncture in the fossa radialis or the so called anatomical “Snuffbox” we aimed to present the feasibility and complications of this new technique.

Methods:

Left distal radial artery was used as an access site in 54 patients admitted to our clinic for coronary angiography and intervention between May 25^th and October 20^th 2017. All of them had pulse in their left distal radial artery. In the laboratory, they had their left arm gently flexed at the shoulder so that the hand was placed over their right groin. The operator stood on the right side of the patient and performed coronary angiography and interventions. During the hospital stay, demographic features and complications were recorded.

Results:

Mean age of patients was 59.3 years and 80% were male. We used Judkins 6 French catheters for the procedures. Seventeen patients admitted with acute coronary syndrome. They all underwent successful left distal transradial coronary angiography and intervention. Primary angioplasty was performed in 10 patients. In total, 20 patients had coronary intervention. Left anterior descending artery was the artery requiring most intervention (11 patients). Two patients experienced brachial spasm requiring crossover to right femoral artery. There were no cases of radial artery occlusion, hematoma, or hand numbness. The radial sheath was removed at procedure termination. Hemostasis was achieved with manual compression.

Conclusion:

Left distal radial approach is safe and feasible as a new technique for coronary angiography and interventions.

Evaluation of the safe zone for percutaneous Kirschner-wire placement in the distal radius: Cadaveric study

Distal radius fractures are a common injury that is often reduced with percutaneous K-wires. The sensory nerves in this area are at risk of injuring from pin placement. Cadaveric studies of the nerve distribution patterns have elucidated certain safe zones for pin placement that limits the risk of sensory nerve injury. These studies have advocated a limited open technique that involves a shallow incision followed by blunt dissection to the bone before a k-wire is drilled into the radius. A previously identified safe zone in the anatomical snuffbox was evaluated in 40 cadaver wrists for k-wire placement via a percutaneous technique that involves putting the pin directly through the skin without an incision or blunt dissection. After k-wire placement each wrist was dissected and sensory nerve distribution relative to the pin placement was evaluated. The variability of the distribution of the sensory nerves, namely the lateral antebracheal cutaneous nerve and the superficial branch of the radial nerve, is such that no truly safe zone exists for pin placement with the percutaneous technique in this area.