Advances in trans-ulnar Intervention: A Successful trans-ulnar Artery Approach for Left Subclavian Artery Stenosis

Abstract

Techniques for vascular intervention have been evolving in the past decades. Trans-radial artery access (TRA) has been emerging and is favorable over trans-femoral access in recent years due to the lower risk of bleeding complications, vascular injury, early mobilization, shorter hospitalization and lesser cost. TRA has its own limitations such as radial artery stenosis, dissection, spasm and crossover. When access from the conventional sites is complicated or unsuccessful, trans-ulnar artery may serve as a feasible and alternative route. Despite posing potential complications similar to TRA, trans-ulnar artery is a relatively safe approach in an experienced trans-radial operator. We, herein, present a challenging case of subclavian artery revascularization performed via retrograde trans-ulnar approach.

The initial experience of 2495 cases of the ulnar artery as default access for coronary diagnostic and interventional procedures at a single center: An observational study

“… 7 Ulnar artery is emerging an attractive option both as upfront access and rescue access in case of failure to obtain radial artery access. 8 , 9 , 10 , 11 , 12 , 13 Meta-analysis performed by Dehal et al included 2744 patients from 5 RCTs and compared TUA and TRA routes in term of success rate of cannulations, efficacy and safety. They concluded that efficacy (comparable MACE rates), safety (comparable access site complications) and procedural times were similar in two routes while TUA results in higher access site failure and crossover rate.…”

Current alternatives to traditional radial approach for coronary interventions: A randomized prospective study of the ulnar and distal radial approaches

“…4,6,7 The ulnar artery is becoming a more attractive choice as a primary access or rescue access if radial artery access cannot be obtained. [8][9][10][11][12][13] More than a decade ago, Trashima and his colleagues were the first to report the feasibility of a transulnar technique for diagnostic catheterization of coronary arteries, 14 and their study was followed by a limited number of subsequent studies. 15 The aim of this study was to compare these two alternative accesses regarding their safety and efficacy.…”