Alternative access sites

While transradial access remains the default approach, alternative access sites should be considered in situations encountering challenging anatomical variants (radial loops, tortuosity, and high take-off), non-palpable radial arteries, radial artery vasospasm, or where large-bore access is required. Crossover to the contralateral left radial artery should be considered before crossover to transfemoral access due to improved safety, quality of life, and cost-effectiveness of transradial compared to transfemoral access [1, 2]. Furthermore, transulnar has been shown to be non-inferior to transradial access and therefore should also be considered before attempting crossover to the transfemoral approach [3-5]. However, transfemoral access remains an important alternative access site for procedures performed within the catheter laboratory [6, 7], and all interventionalists should retain proficiency in the technique to reduce the risk of complications in situations where its use is mandated [8]. As a last resort, transbrachial access can be performed either percutaneously or via arterial cutdown to the brachial artery if other access options are not available [9-11].