# Feasibility and safety of the distal radial access for vascular access interventional therapy

## TL;DR

This study shows that using the distal radial access for vascular access interventional therapy is both feasible and safe, with low complication rates.

## Contribution

The study is the first to establish the feasibility and safety of distal radial access for vascular access interventional therapy.

## Key findings

- VAIVT success rates were similar between the DRA and standard access groups.
- DRA had no puncture site hematomas and no cases of dialysis access-associated steal syndrome.
- Most patients who had a prior DRA procedure used it again for subsequent VAIVT.

## Abstract

Distal radial access (DRA) has emerged as an alternative approach to reduce the risk of radial artery occlusion in coronary angiography. Vascular access intervention therapy (VAIVT) is traditionally used to treat arteriovenous fistula stenosis. However, the feasibility and safety of DRA for VAIVT have not been established. This study aimed to evaluate the feasibility and safety of using DRA for VAIVT. We included 421 consecutive VAIVT procedures for upper limb arteriovenous fistulas retrospectively. DRA for VAIVT was performed in 181 procedures (DRA group), and the remaining procedures were approached through the brachial artery or vein (SA group: standard access group). Clinical follow-up was performed to evaluate the incidence of hematoma and dialysis access-associated steal syndrome (DASS). The mean follow-up duration following VAIVT was 24.0 months. The VAIVT success rate did not differ significantly between the groups (DRA: 97.8% vs. SA: 98.3%; P = 0.73), neither did the incidence of puncture site hematoma (DRA: 0.0% vs. SA: 0.8%; P = 0.51). There were no complications with DASS symptoms in the DRA group during the clinical follow-up. In the DRA group, 90 patients underwent a subsequent VAIVT procedure, and 85 patients (94.4%) underwent a subsequent VAIVT by DRA. DRA is a feasible and safe strategy for VAIVT and could be considered an option for VAIVT.

The online version contains supplementary material available at 10.1007/s12928-025-01127-4.