• Distal vs conventional radial access: a meta-analysis of arterial size and procedural implications

    This abstract ( reference A100096CS ) was accepted for EuroPCR



    SALZILLO Carmine (2), BASILE Mattia (1), SALZILLO Carmine (2), JURADO-ROMÁN Alfonso (1), RAUL Moreno (1), CLAUDIU Ungureanu (5), FERRANTE Giuseppe (3), SGUEGLIA Gregory A. (4), GASPARDONE Achille (4)

    (1) La Paz University Hospital, Madrid, SPAIN; (2) Hospital of Erba, Province of Como, ITALY; (3) Humanitas Rozzano - via Manzoni 56, Metropolitan City of Milan, ITALY; (4) Sant'Eugenio Hospital, Metropolitan City of Rome Capital, ITALY; (5) CHU HELORA - Hôpital de La Louvière - Site Jolimont, La Louvière, BELGIUM

    AIMS
    Distal radial access is increasingly adopted for coronary and non-coronary interventions, yet reported arterial diameters at distal and conventional radial puncture sites are inconsistent. This systematic review and meta-analysis aimed to quantify radial artery diameter at distal radial access and conventional transradial access puncture sites and to define their anatomical difference, including sex- and region-specific variations

    METHODS AND RESULTS
    A systematic review and meta-analysis of studies comparing arterial diameter at distal radial access and conventional transradial access puncture sites was performed using random-effects models. Bayesian analyses were conducted to assess robustness. Thirty-eight studies including 12,249 patients were analysed. Mean diameter at the puncture site was 2.57 ± 0.53 mm for conventional transradial access and 2.22 ± 0.46 mm for distal radial access. The distal radial artery was consistently smaller by approximately one French size (mean difference −0.36 mm, 95% confidence interval −0.41 to −0.31), with concordant Bayesian estimates. No significant differences were observed according to study design. Modest regional variation was identified, with larger diameters in North American populations and smaller diameters in Asian populations. Measurements obtained at the dorsum of the hand were smaller than those at the anatomical snuffbox. In sex-specific analyses, both access sites were larger in men than in women, and women’s conventional transradial access diameter did not differ significantly from men’s distal radial access diameter

    CONCLUSIONS
    The distal radial access puncture site is approximately one French smaller than the conventional transradial access puncture site. This anatomical difference supports the use of thin-wall or sheathless strategies when distal access is selected. Pre-procedural ultrasound assessment may facilitate personalised sheath selection, optimise the sheath-to-artery ratio and help maintain a radial-first approach