Operative access to the left radial artery on the back of the hand for X-ray endovascular surgical interventions

• Milenkin B.I.
• Prazdnikov J.N.
• Baranov G.A.

Abstract

Objective. The study was aimed at improving the technique and results of X-ray endovascular surgical interventions by investigation of the anatomical and clinical aspects of surgical access to the left radial artery on the back of the hand.

Patients and methods. From 2019 to 2021, we operated on a total of 210 patients randomly assigned to undergo X-ray endovascular surgical interventions through distal approaches from the radial artery on the back of the left hand or in the lower third of the right forearm. The distal approach to the radial artery of the back of the left hand was successful in 100 of 104 patients, and the conventional radial approach in the lower third of the right forearm in 100 of 106 patients. All patients underwent anthropometric measurements and Doppler ultrasonography in the zone of the arterial access. We evaluated the potential efficacy and feasibility of accesses for the intervention, the frequency of access conversion, early (hemorrhagic) and late local postoperative complications (occlusion of the radial artery) associated with a specific type of the arterial access. Subjective pain perception was evaluated using a visual analog scale during both the vascular access and hemostatic bandage application.

Results. Distal radial access on the back of the left hand was effectively performed in 96.2% of cases, and conventional radial access on the inner surface of the lower third of the right forearm in 94.3% of cases. The analysis of X-ray endovascular surgical interventions was performed in 100 patients with successful puncture of the radial artery on the back of the left hand (Group 1) and in 100 patients with successful conventional puncture of the radial artery on the internal surface of the lower third of the right forearm (Group 2). The mean age was 68.4±11.9 and 65.2±11.2 years in Group 1 and Group 2 patients, respectively (p<0.05). There were no statistically significant between-group differences in gender or anthropometric parameters (p<0.005). In male patients, the internal diameter of the radial artery on the inner surface of the lower third of the forearm (2.36±0.09 mm) and on the back surface of the hand (1.83±0.1 mm) was significantly larger (p<0.0001) compared with women (2.14±0.11 mm and 1.70±0.09 mm, respectively). In men, the average wrist circumference was 17.98 cm, and in women – 16.20 cm. The correlation analysis identified a statistically significant association of both the internal diameter of the radial artery on the inner surface of the lower third of the forearm (p<0.0001) and the diameter of the vessel on the back of the hand (p<0.0001) with the results of measuring the circumference of the wrist. There was no statistically significant relationship between the diameter of the artery on the inner surface of the lower third of the forearm (p=0.4118) and on the back surface of the hand (p=0.2242) with the body mass index. In Group 1 patients, the time of successful artery puncture was longer (p<0.0001) compared with that in Group 2 patients (18.8±4.3 s versus 12.2±2.8 s, respectively). However, no statistically significant differences in the time of X-ray, time of intervention and number of punctures were revealed. None of the Group 1 patients had clinically meaningful hemorrhagic complications at the site of vascular access in comparison with Group 2 patients (p<0.0001). After the intervention and within an average of 41.3±9.8 days, no radial artery occlusion was detected in Group 1 patients, whereas six (6%) Group 2 patients were found to have radial artery occlusion within 40.9±7.7 days postoperatively (p=0.0289). Comparing the intensity of pain during vascular access by a visual analog scale demonstrated no between-group statistically significant differences (p>0.05). Assessing the comfort of the compression dressing applied for hemostasis showed a significant advantage in the group of patients with distal access (p<0.0001).

Conclusion. Operative access to the left radial artery on the back of the hand for X-ray endovascular surgical interventions may and should be more widely included in clinical practice. Such access may be considered as a rational alternative to the conventional puncture of the radial artery in the lower third of the forearm.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Milenkin B.I., Prazdnikov E.N., Baranov G.A.; data collection and handling – Milenkin B.I.; statistical processing – Milenkin B.I.; draft manuscript preparation – Milenkin B.I., Baranov G.A.; manuscript revision – Prazdnikov E.N., Baranov G.A.

For citation: Milenkin B.I., Prazdnikov E.N., Baranov G.A. Operative access to the left radial artery on the back of the hand for X-ray endovascular surgical interventions. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2023; 29 (3): 109–18. DOI: https://doi.org/10.33029/1027-6661-2023-29-3-109-118 (in Russian)

Keywords:X-ray endovascular surgical interventions; distal radial access; radial artery; back of the hand