Limitations
The radial artery diameter was assessed by Kaledin et al. using
ultrasound10: the average diameter was 2.4 mm in the anatomical snuff
box, slightly smaller than the average diameter of 2.7 mm of the radial
artery in the forearm. The puncture is therefore more challenging, and a
learning curve must be overcome. In the Kiemeneij 11 series of patients,
the distal radial artery was too weak to attempt a puncture in the
radial fossa in 23% of cases. The dTRA technique is certainly not
suitable for unselected patients, for the simple reason that, in a
substantial number of patients, no clear pulse is palpable in the
anatomical snuffbox.11 In addition, in complex PCI procedures that
require greater guidance catheter diameter, a catheter without a sheath
may be required. In addition, as the access site is more distal, regular
catheters in length (100 cm) may be too short to cannulate the coronary
arteries of tall patients and extra length catheters (110 or 115 cm) may
be necessary for these patients. Some hemostatic devices designed for
forearm compression may be too short for distal radial access.