The Right Snuffbox Approach

 

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

This short clip (01.35min) shows Dr Y Kim (Seoul, KR) carrying out a snuffbox procedure via the right wrist.
 
In this procedure, patients need 90° internal rotation of the right wrist compared with a right conventional radial approach. 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.