Preserved hand perfusion as rationale for distal radial artery access: a laser doppler study

The distal radial artery access has been proposed as an alternative route to overcome some limitations of conventional radial access, of which radial artery occlusion is one of the most frequent complications.

This study aimed to evaluate the impact of distal versus proximal radial artery occlusion on hand perfusion by simulating both conditions and comparing their effects.

A prospective, observational study was conducted on 50 healthy volunteers. Laser Doppler perfusion imaging with PeriScan PIM III device (Perimed AB, Järfälla, Sweden) was employed to quantify palmar perfusion under three conditions: baseline, simultaneous occlusion of the distal radial and ulnar arteries, and simultaneous occlusion of the proximal radial and ulnar arteries. The hand perfusion was quantified in terms of perfusion units (PU).

Simultaneous proximal radial and ulnar occlusion reduced perfusion by ~90% (58.18 ± 23.18 PU vs. 5.91 ± 4.48 PU, p<0.001), while distal radial artery occlusion with absent ulnar flow reduced palmar perfusion by ~50% of baseline (58.18 ± 23.18 PU vs. 28.46 ± 12.69 PU, p<0.001). Proximal radial occlusion impaired perfusion more than distal occlusion (28.46 ± 12.69 PU vs. 5.91 ± 4.48 PU, p<0.001), suggesting that the superficial palmar branch of the radial artery, proximal to the distal puncture site, contributes significantly to hand perfusion. No significant differences were observed between sexes or between normal-weight and overweight/obese subjects.

This is the first study to demonstrate, through perfusion imaging, the anatomical rationale supporting distal radial artery access. The preserved perfusion following distal radial artery occlusion confirms the safety of this technique, particularly in cases of compromised ulnar flow.

Graphical abstract study flow