PURPOSE: Access for coronary angiography and intervention is increasingly achieved via the radial artery to avoid the vascular complications of femoral access. However, use of radial access can be limited in 10–30% cases due to incomplete palmar collateral support, access site occlusion / failure, and anatomical variations. Compared to the transradial approach, the ulnar artery is a relatively new technique and is especially useful in the above situations. We report a retrospective analysis of our experience of transulnar catheterization in patients with radial artery occlusion.
METHODS: 33 patients (68±3 years) with limited vascular access who underwent coronary angiography, followed (n=18) or not followed (n=15) by angioplasty, by transulnar approach were analyzed retrospectively. All these patients had documented occlusion of radial artery and normal reverse Allen test, before attempting ulnar approach. All patients had angiogram through the sheath at the end of the case, which showed excellent collateral circulation. Major adverse cardiac events (MACE) were recorded till the first follow-up clinic visit (Mean 35±12 days).
RESULTS: Procedural success rate was 100% in both diagnostic and intervention group. The average time for cannulation, and that for catheterization, fluoroscopic time and amount of contrast used were comparable with those of the radial approach at our institution and previously reported (p = NS). Complications such as bleeding, aneurysm, loss of ulnar pulse, ulnar nerve injury, loss of circulation and/or ischemic symptoms of the hand were not observed in any patient during the hospital course and at first follow-up. Small hematomas were observed in 2 patients (6% cases).
CONCLUSION: The transulnar approach for diagnostic and therapeutic coronary interventions is an effective and feasible alternative to transradial approach, and could be safely used in patients with documented radial artery occlusion in stead of femoral access.
CLINICAL IMPLICATIONS: The transulnar approach has the potential advantage of saving the radial artery for its potential future use as coronary bypass conduit and also avoiding the use of femoral artery for access and the vascular complications associated with this.
DISCLOSURE: Ruby Satpathy, No Financial Disclosure Information; No Product/Research Disclosure Information