What is the preferred hemostasis method for coronary angiography through the palmar artery access?

Trans-palmar catheterization has been considered to be safe and feasible and choosing a reliable hemostasis method is essential to confirm it. The aim of our study was to compare the efficacy and safety of three hemostasis approaches containing ulnar TR band, manual compression and wrist hyperextension in patients undergoing trans-palmar coronary angiography (CAG). In a non-randomized clinical trial, a total of 106 patients undergoing diagnostic CAG by tarns-palmar access were divided into three groups: ulnar TR band, manual compression and wrist hyperextension. Duration of primary hemostasis, patient satisfaction, puncture site pain severity, hospitalization time and local neuro-vascular complication were evaluated and compared in hospital and 30 days follow-up. The mean age of the patients was 62.9 ± 7.4 years and 72 patients (67.9%) were male. Primary hemostasis time was significantly shorter in hyperextension (11.5 ± 2.10 min) and manual compression groups (12.3 ± 2.20 min) than with TR band group (24.7 ± 10.25 min) (p value < 0.0001). Patient's satisfaction was higher in hyperextension approach (9.4 ± 0.65) than manual compression (8.8 ± 0.79) and TR band group (8.2 ± 0.90) (p value < 0.0001). The most pain was seen in the TR band and the less in hyperextension group until 4 h after the procedure (p value < 0.0001). Hematoma, numbness and ulnar artery occlusion as well as hospitalization time did not have significant statistical differences (p value > 0.05). In conclusion, between three methods of hemostasis in trans-palmar catheterization, hyperextension approach is the preferred method because of effectiveness, safety and less time consuming hemostatic method compared others.