Limitations
The radial artery diameter was assessed by Kaledin et al. using ultrasound10: the average diameter was 2.4 mm in the anatomical snuff box, slightly smaller than the average diameter of 2.7 mm of the radial artery in the forearm. The puncture is therefore more challenging, and a learning curve must be overcome. In the Kiemeneij 11 series of patients, the distal radial artery was too weak to attempt a puncture in the radial fossa in 23% of cases. The dTRA technique is certainly not suitable for unselected patients, for the simple reason that, in a substantial number of patients, no clear pulse is palpable in the anatomical snuffbox.11 In addition, in complex PCI procedures that require greater guidance catheter diameter, a catheter without a sheath may be required. In addition, as the access site is more distal, regular catheters in length (100 cm) may be too short to cannulate the coronary arteries of tall patients and extra length catheters (110 or 115 cm) may be necessary for these patients. Some hemostatic devices designed for forearm compression may be too short for distal radial access.