Back Hand Approach to Radial Access: The Snuff Box Approach

Transradial access is becoming the default strategy for routine coronary procedures, but there is still room for improvement. For instance, left radial access is known to offer some advantages for graft cases, less tortuosity, amongst other potential benefits. The downside has been the applicability of this access point on patients with a larger body mass index both from the viewpoint of the patient and the operator. The patient must lay with their arm in a supine position and the operator as a result must stand in a flexed position for an unknown period of time. Additionally, patients with various orthopedic injuries, including frozen shoulders, on may be unable to supinate their wrist for optimal access. One solution to this dilemma is to approach the radial artery from the dorsal aspect of the hand so the wrist can pronate naturally if body habitus requires the arm to be shifted towards the operator. This report outlines the steps and background behind this approach and an educational opportunity for those interested in expanding their access skills.