الفهرس 
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Abstract
Egypt is the most populous country in the Middle East and North Africa and has more than 15% of the cardiovascular deaths in the region, but little is known about the prevalence of traditional risk factors and treatment strategies in acute coronary syndrome (ACS) patients across Egypt.
The purpose of our study was to compare immediate outcomes between the conventional transradial approach versus distal transradial approach for diagnostic and interventional coronary procedures.
This was a clinical study that was included 60 patients who presented to the Cathetrization Lab in Ahmed Maher Teaching Hospital to perform transradial Coronary angiogrophy for diagnosis and treatment of Ischemic heart events
Inclusion criteria:
Patients eligible for coronary angiography and coronary intervention for coronary artery disease or preoperative angiography
Exclusion criteria
1.Patient undergoes coronary intervention from radial access.
2. Patient with past history of hand orthopedic surgery.
3.Patient with past history of vascular hand surgery.
4.Patient with past history of CABG using radial artery graft.
Each patient was subjected to the following
1- Complete history taking, risk factors.
2- Clinical examination and ECG.
3- Patients had been divided into two groups as follows:
group (A):50% of patients will undergo the procedure through through distal transradial apporach (The Anatomical Snuffbox).
group (B ):The other half of the patients will undergo the procedure the conventional Transradial approach.
4- Follow up of all patients during hospital stay
The our study suggestive that the incidence of Radial Artery occlusion 26.7 % in Radial Group, significant P Value in comparison with Snuff box group.
The our study suggestive that hospital stay more shorter in time in snuff box than radial group with significant P Value.
The our study suggestive that patient Satisfaction with Snuff box group more than radial group without significant value.
SUMMARY
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An advantage of snuffbox approach is the to maintain Radial artery Patent to allow the radial harvesting in CABG if needed after coronary intervention , also IHD patient is multi factorial in Risk Factor which the same risk factor for CKD, snuff box allow patent radial artery for A–V Shunt if needed.
But in comparison with all complication no significant p value between the snuff box group and the radial group.