The Left Snuffbox Approach

 

Radial access can be achieved via the anatomical snuffbox for coronary angiography and percutaneous coronary intervention (PCI).

This short clip (01.15min) shows Dr Y Kim (Seoul, KR) carrying out a snuffbox procedure via the left wrist.

The patient places the left upper arm over a cushion and bends the elbow slightly so that the left hand is naturally located in the left groin site.

Local anaesthesia was achieved through a 1-ml lidocaine hydrochloride injection into an anatomical snuffbox with a 26-gauge needle. Thereafter, puncture was performed using a 21-gauge open needle using the anterior wall puncture technique. After successful puncture, a 0.025-inch straight wire is inserted, followed by an insertion of the radial sheath (Prelude Radial®; Merit Medical, UT, USA). After successful cannulation, a combination of 0.2 mg of nitroglycerin, 2.5 mg of verapamil, and 3,000 units of unfractionated heparin diluted in 10 ml of saline solution is administered to prevent arterial spasm in all patients except for those scheduled for ergonovine provocation test.

Reference:
1. Yongcheol K, SungA B, et al. Invasive physiological assessment of myocardial bridge via the left snuffbox approach. Kardiol Pol 2019;77(9):892-893.