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The transradial approach

An increasingly used standard for coronary diagnosis and interventions

Der radiale Zugang

Immer häufiger Standard für Koronardiagnostik und Interventionen

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Abstract

In the 20 years since its introduction, radial access for diagnostic and interventional coronary procedures has been well validated in countless scientific studies. Nevertheless, the use of this access route varies greatly among—and even within—countries. Fear of the unknown may make some experienced interventionalists hesitant to adopt the transradial approach in spite of its proven advantages. In our review, we describe practical aspects of the transradial access, such as the role of Allen’s test in patient selection and considerations on the optimal puncture technique of the radial artery. Catheter selection, anatomic variations which may complicate access, as well as strategies to avoid and/or manage possible complications are outlined. Finally, we review the literature on the reduction of access site complications by adopting the transradial approach. Even in interventions for acute myocardial infarction, transradial access can be used safely and effectively. In addition to a reduced rate of access site complications, a reduction in overall in-hospital major adverse cardiac events has been demonstrated. The advantage regarding access site complications could be seen even when closure devices were utilized for transfemoral procedures.

Zusammenfassung

Etwa 20 Jahre nach Einführung des transradialen Zugangs für Herzkatheteruntersuchungen und Koronarinterventionen sind die Vorteile dieses Verfahrens im Vergleich zum transfemoralen Vorgehen gut untersucht; dennoch kommt es unterschiedlich häufig zur Anwendung. In dieser Arbeit werden praktische Aspekte des transradialen Zugangs dargestellt, die Bedeutung des Allen-Tests bei der Auswahl geeigneter Patienten und die optimale Punktionstechnik der A. radialis. Anatomische Varianten der A. radialis können Probleme verursachen und müssen bedacht werden. Zur Koronarangiographie werden üblicherweise Standardkatheter wie beim transfemoralen Vorgehen verwendet. Komplikationen sind bei der Beachtung von wenigen, wichtigen Grundregeln selten und können in der Regel sicher gehandhabt werden. In klinischen Untersuchungen wurde gezeigt, dass Blutungen im Rahmen von Koronarinterventionen mit einem schlechteren Outcome verbunden sind. Durch die Anwendung des transradialen Zugangs können Blutungen an der Punktionsstelle signifikant verringert werden. Auch bei akuten Myokardinfarkten kann der transradiale Zugang sicher eingesetzt werden; im Vergleich zur transfemoralen Technik ließ sich nicht nur eine geringere Komplikationsrate an der Punktionsstelle, sondern auch ein besseres kardiovaskuläres Outcome nachweisen. Selbst beim Einsatz von Verschlusssystemen im Rahmen des femoralen Zugangs zeigte sich bezüglich der Komplikationsrate ein Vorteil für den transradialen Zugang.

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Conflict of interest

The corresponding author states that he has a consultancy contract with the company B. Braun.

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Authors and Affiliations

  1. Medizinische Klinik 2, Kardiologie, Angiologie, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland

    J. Ludwig, S. Achenbach, W.G. Daniel & M. Arnold

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  1. J. Ludwig
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  2. S. Achenbach
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  3. W.G. Daniel
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  4. M. Arnold
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Correspondence to J. Ludwig.

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Ludwig, J., Achenbach, S., Daniel, W. et al. The transradial approach. Herz 36, 386–395 (2011). https://doi.org/10.1007/s00059-011-3483-y

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