Transradiale

Transradial, or transradiale, refers to an arterial access route through the radial artery at the wrist used for diagnostic and interventional vascular procedures, most notably coronary angiography and percutaneous coronary intervention (PCI). It is an alternative to transfemoral access and has become widely adopted in many centers due to safety and comfort benefits.

The approach is primarily employed for coronary catheterization but is also used for other arterial interventions, including peripheral and some neurovascular procedures, when suitable vessels are available. Before access, clinicians assess hand collateral circulation with tests such as the modified Allen test or Barbeau test to ensure the hand will receive sufficient blood supply if the radial artery is compromised.

Technique and workflow typically involve puncture of the radial artery, insertion of a sheath, and administration of anticoagulation and vasodilators to minimize spasm. The procedure proceeds with appropriate catheters and guidewires for the diagnostic or therapeutic indication. After completion, hemostasis is achieved with mechanical compression devices or manual compression. Patients are often ambulatory sooner than with transfemoral access.

Advantages include a lower risk of major vascular bleeding and hematoma, earlier ambulation, reduced immobilization, and higher patient comfort in many cases. Limitations encompass unsuitable radial anatomy or severe atherosclerotic disease, small-caliber arteries, a risk of radial artery spasm or occlusion, and the potential need to convert to an alternative access site if access is not feasible.

Complications are generally infrequent but can include radial artery occlusion, hematoma, arterial perforation, nerve injury, and, rarely, ischemic complications of the hand. The transradial approach has become a standard option in contemporary interventional practice, supported by guideline recommendations and numerous outcome studies.