Anatomic basis and physiological rationale of distal radial artery access for percutaneous coronary and endovascular procedures

Transradial access offers important advantages over transfemoral access, including overall increased procedure comfort and better outcomes. Still, complications of transradial access exist, with radial artery occlusion being the most clinically relevant one. Puncture sites in the hand allowing distal radial artery access have initially been described for anterograde angioplasty of occluded radial arteries and could represent a valuable alternative to traditional wrist puncture for radial artery catheterization. What may at first appear as a "radialist eccentricity" definitely has a sound rationale, which the authors review. Knowledge of the anatomic and physiological principles at the basis of distal radial artery access is essential to promote rigorous understanding and practice of this new opportunity for both patients and interventional specialists. (c) 2018 by the American College of Cardiology Foundation.