Archief Roodbont

Is the Radial Approach for Everyone?
There are a few prerequisites for patients to be a candidate for the transradial approach. The first is confirmation of a dual, or "protected", blood supply to the hand. The radial artery loops around the hand and joins the ulnar artery. Both arteries supply blood to the hand and fingers. It is precisely this dual blood supply that makes the radial technique safe. Should the radial artery close up (a complication seen in a small percentage of cases) the clinical result tends to be benign, because the ulnar artery continues to function.

The first step a cardiologist takes in deciding on the radial approach is an Allen test to assess that both radial and ulnar arteries are functioning normally -- a simple test that can be done by compressing the arteries by hand at bedside or in the doctor's office. If they are not normal, then the femoral approach is preferred. Some other contraindications exist, such as the need to use larger devices during the angioplasty, pre-existing bypass grafts in certain areas or tortuous vessels that may prevent the catheter from navigating to the coronaries from the arm. About 30-40% of patients are not candidates for radial access.