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George T Broderick
American Heart Hospital Journal Volume 8 No.1

The use of the radial artery to achieve vascular access to perform cardiac catheterization and percutaneous coronary intervention is an inherently appealing approach, with its potential to improve patient satisfaction and lower bleeding complications. Transradial catheterization has been employed for over 20 years, yet it is still not practiced frequently in most catheterization centers in the US. Currently, only 1-3% of coronary catheterizations in the US are performed transradially,¹ but many operators are using this approach in the overwhelming majority of their procedures. There is seemingly a strong reticence in the US for operators to take up the gauntlet of transradial catheterization, most likely related to an underestimation of the benefits to patients in its use and an exaggerated concern about the learning curve in acquiring expertise in the technique. Operators who are quite comfortable using the femoral approach and who do not perceive that the approach is associated with an excess of vascular complications in their hands see little reason to take on the 'burden' of learning the technique, mastering the anatomic differences inherent in transradial access, and becoming comfortable with its use. Fortunately, the learning curve for experienced operators is not steep and, with persistence and dedication, operators can quickly become adept in the transradial technique.

Transradial catheterization and percutaneous intervention have definite advantages in terms of patient comfort and satisfaction, in addition to easing nursing and postprocedure care and reducing the rate of vascular complications. There are pitfalls with the technique, such as difficulty in gaining access through tortuous vascular anatomy and difficulties in adequate guide support and coronary cannulation, but with increasing operator experience these problems can be minimized. Establishing a successful transradial cardiac catheterization program can be a boon for patients and staff as well as the operator. The safety of this approach has been consistently demonstrated compared with femoral access, and this benefit as well as patient convenience is driving the push toward transradial access.

Patient Selection and Access
Although experienced transradial operators can successfully perform most coronary interventional procedures, initial patient selection is critical in facilitating the learning curve and leading to early success in learning the technique. The initial selected patients should be stable patients without acute coronary syndromes who are less than 70 years of age with an easily palpable radial pulse and who are not small in stature.

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