Adem AKTAN, Raif KILIÇ, Tuncay GÜZEL, Burhan ASLAN, Ali EVSEN, Abdulkadir ARPA, Mehmet Sait COŞKUN, Muhammed Raşit TANIRCAN, Mehmet Zülküf KARAHAN
Cardiovascular Surgery and Interventions - 2026;13(2):96-100
Objectives: This study aimed to identify patient-based clinical and demographic factors affecting the success of the first puncture attempt in patients undergoing distal radial access (dTRA) for coronary angiography and interventional procedures. Patients and methods: The study was designed as a retrospective, single-center observational study. Two hundred eighty-six consecutive patients who underwent dTRA procedures between January 2023 and March 2026 were included in the analysis. All puncture procedures were performed by a single experienced operator, with palpation guidance from the anatomical snuffbox region. Univariate and multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to identify independent variables predicting first-attempt success. Results: Successful puncture was achieved on the first attempt in 70.6% (n=202) of the study population. Multivariate analysis showed that advanced age (odds ratio [OR]: 0.93, p<0.001) and female sex (OR: 0.50, p=0.015) were associated with a lower likelihood of first-attempt success, whereas higher body mass index (BMI) (OR: 1.17, p=0.001) was associated with a higher likelihood of success. The group with failure on the first attempt had significantly longer puncture time and a higher rate of access site complications (hematoma, spasm, etc.) (14.3% vs. 6.9%; p=0.049). The discriminatory power of the model was calculated as area under the curve: 0.721 (95% confidence interval: 0.658-0.785) in the ROC analysis. Conclusion: The first-attempt success rate of dTRA was associated with patient age, sex, and BMI. Ultrasound-guided puncture strategies are recommended to increase procedural success and reduce vascular complications, especially in high-risk patient groups such as the elderly, women, and those with low BMI.
