Rebirth of left radial artery access: could this be the ‘right’ radial artery?

Abstract

Cardiac catheterization has several risks, notably which include bleeding, stroke and death. The transradial (TR) approach to catheterization is associated with a lower bleeding risk. The right radial approach is the default method in most laboratories and the left radial artery (LRA) serves as the bail-out approach. This article discusses the advantages and disadvantages of transfemoral and TR access routes. The authors envisage an increased adoption of the LRA approach, due to the anatomical superiority and ease of catheter engagement afforded by this approach. The authors discuss ways to increase operator ease for LRA in the laboratory and propose a novel way to improve LRA work-flow.

Keywords:

• cardiac catheterization
• left radial artery
• right radial artery
• transfemoral
• transradial

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Transradial approach offers several advantages over the transfemoral approach for cardiac catheterizations notably reduced bleeding complications, higher patient comfort and early ambulation with reduced hospital stays.

• The right radial artery is widely used as the preferred transradial approach.

• Although the left radial artery is used as a bail-out access site, it offers advantages including engagement of the left internal mammary artery, and anatomic ease with less catheter manipulation.

• Laboratory set ups will need to be customized with operator training to increase use of the left radial artery.