Distal radial access in interventional cardiology: technique, pitfalls and recommendations

Distal radial access (DRA) is a relatively novel approach in interventional cardiology and represents an evolution of transradial techniques. This approach involves accessing the distal radial artery (DRart) in the anatomical snuffbox, offering an alternative to traditional radial and femoral access, with demonstrated benefits over conventional transradial access (TRA), such as a lower rate of radial artery occlusion, shorter hemostasis time, and improved patient comfort. DRA is technically more demanding compared to TRA. The smaller size of the DRart and the anatomical landmarks that surround it make it more difficult to cannulate, especially for operators who are less experienced with the approach. This increased difficulty can result in higher initial failure rates and longer procedural times, all of which contribute to a steeper learning curve. This review aims to provide a comprehensive guide to the use of DRA for the interventional cardiologist to take full advantage of the approach by summarizing current evidence and experienced operator recommendations, focusing on practical recommendations on techniques to improve procedural success, minimize complications, and optimize results.