Introduction
According to the World Health Organization (WHO), cardiovascular disease
(CVD) is the leading cause of death in the world. It is estimated that
17.7 million people died from CVD in 2015, representing 31% of all
deaths globally. In addition, more than three quarters, about 37%, of
CVD deaths occur in low- and middle-income countries, and, in Brazil, CVD is responsible for about 384 thousand deaths per year [1].
In this context, prophylactic and reparative cardiovascular
interventional measures using angioplasty and catheterization techniques
are necessary. Thus, the use of the radial artery as an access route for
diagnostic procedures in cardiology was first described in the
literature by Lucien Campeau in 1989 [2]. Afterward, Kiemeneij
published the first three patients submitted to angioplasty with
stenting by this route [3]. Then, in 1997, the same author published
the ACCESS study [4], comparing the coronary intervention of the
radial, brachial, and femoral accesses. As the main clinical outcomes of
the use of the radial artery route, an important reduction in
hemorrhagic complications were found. In addition, this safety profile
has also been demonstrated in patients with acute coronary syndromes
[4].
Therefore, the access by transradial approach (TRA) is consolidated
through studies that show a positive association between this path and
the reduction in cardiac mortality, mediated by a lower rate of vascular
complications, including in patients undergoing primary and primary
angioplasty. rescue [5-8]. As scientific evidence of this, a
retrospective analysis of the British Columbia Database of cardiac and
renal records showed that progression to chronic renal failure after six
months of cardiac catheterization occurred in 0.2% of those who
underwent the TRA procedure [9].
In this sense, the distal transradial approach (dTRA) was advocated to
reduce the risk of occlusion of the radial artery in the forearm,
preventing reintervention through the same access site and complications
at the bleeding and vascular site [10,11]. In addition, dTRA is also
the main site for retrograde recanalization of radial artery occlusion.
According to Kaledin et al., The flow of anterograde blood would be
preserved through the superficial palmar arch (snuffbox), thus, the risk
of thrombosis and occlusion of the extensive radial artery in the
forearm would be minimized [12]. In addition, this arterial entry is
beyond the forearm compartments, reducing the risk of compartment
syndrome. Finally, the dTRA provides better operator and patient
comfort, especially when using the left radial approach (ldTRA)
[12].
Therefore, the present study aimed to carry out a systematic review of
the main considerations of prophylactic and reparative cardiovascular
interventional procedures through the distal transradial approach in the
anatomical snuffbox.