Effectiveness of Ulnar Artery Catheterization After Failed Attempt to Cannulate a Radial Artery

Lanspa, Thomas; Williams, Mark A.; Heirigs, Rick

doi:10.1016/j.amjcard.2005.02.032

Cited by 24 publications

(15 citation statements)

References 6 publications

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“…However, even with the possible occurrence of this event, in only 2.5–5% of patients would there not be a complete deep palmar arch to protect against ischemic complications. In spite of the absence of a complete deep palmar arch, recruited collateral vessels could guarantee a sufficient blood flow in order to avoid ischemic complications 8,12,13 . Greenwood et al proved the dynamics of the collateral circulation of the hand 14 .…”

Section: Discussionmentioning

confidence: 99%

Performance of Coronary Procedures through the Transulnar Access without Assessment of the Integrity of the Deep Palmar Arch

Andrade¹,

Tebet²,

Andrade³

et al. 2008

J Interven Cardiology

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Occurrence of ischemic complications after transulnar coronary procedures is virtually absent. The presence of a complete deep palmar arch in approximately 95% of the population as well as the great capacity of the collateral circulation of the hand might justify these findings. We report the occurrence of complications in 62 patients submitted to coronary procedures through the transulnar approach, without assessment of the integrity of the deep palmar arch by the inverse Allen's test. The rate of asymptomatic occlusion of the ulnar artery was 3%, without any ischemic complication. We believe the performance of Allen's test is not necessary when using transulnar access.

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Section: Discussionmentioning

confidence: 99%

Performance of Coronary Procedures through the Transulnar Access without Assessment of the Integrity of the Deep Palmar Arch

Andrade¹,

Tebet²,

Andrade³

et al. 2008

J Interven Cardiology

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“…When TRA cannot be performed, transulnar access has been proposed as a feasible alternative for those interventional cardiologists who like to stick with the 'wrist philosophy' [40,41]. However, given that data are still limited and ulnar anatomy is surely more challenging, it is too early to recommend the transulnar access as the second choice when TRA is not possible.…”

Section: Nobody Is Perfect: Common and Rare Complicationsmentioning

confidence: 99%

Overview of the transradial approach in percutaneous coronary intervention

Amoroso

Laarman

Kiemeneij

2007

Journal of Cardiovascular Medicine

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Thirteen years have passed since the first percutaneous coronary intervention was performed at Onze Lieve Vrouwe Gasthuis in Amsterdam using the transradial approach (TRA). Since then TRA has spread through the interventional community and many centres have now adopted TRA as the arterial access of choice. This review is focused on the hot issues and the latest developments in this field. The following subjects will be addressed and discussed: drawbacks and learning curve, procedural technique, indications (with particular attention to acute coronary patients), complications, contraindications, nurse workload, patient management, and economics.

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“…153 Hand ischemia has been reported in pediatric patients with prolonged ulnar artery cannulation in the setting of prior radial artery cannulation. 23,154 -157,159 This approach has been safely used in patients with adequate radial artery flow, 23,152,155,159 in those with compromised radial artery flow resulting from multiple punctures, 156,157 and in those with known chronic radial artery occlusion. 16,23,151,154 -158 There is increasing interest in the use of the ulnar artery as an entry site for percutaneous coronary interventions when there are few other portal options.…”

Section: Ulnar Artery Cannulationmentioning

confidence: 99%

“…23,154 -157,159 This approach has been safely used in patients with adequate radial artery flow, 23,152,155,159 in those with compromised radial artery flow resulting from multiple punctures, 156,157 and in those with known chronic radial artery occlusion. 154,156 152 Similar rates of access success (transulnar 93.1% vs transradial 95.5%), complications, and asymptomatic artery occlusions (transulnar 5.7% vs transradial 4.7%) were reported.…”

Section: Ulnar Artery Cannulationmentioning

confidence: 99%

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzeziński¹,

Luisetti²,

London³

2009

Anesthesia &Amp; Analgesia

295

226

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Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.

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Effectiveness of Ulnar Artery Catheterization After Failed Attempt to Cannulate a Radial Artery

Cited by 24 publications

References 6 publications

Performance of Coronary Procedures through the Transulnar Access without Assessment of the Integrity of the Deep Palmar Arch

Performance of Coronary Procedures through the Transulnar Access without Assessment of the Integrity of the Deep Palmar Arch

Overview of the transradial approach in percutaneous coronary intervention

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

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