Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion

Abstract

SummaryTo investigate the postprocedural cardiovascular events and vascular outcomes, including hand ischemia and neurological compromise, after transulnar (TU) catheterization in ipsilateral radial artery occlusion.Previous randomized trials have shown that the transulnar (TU) approach for coronary angiogram and intervention has safety and outcomes similar to those of the transradial (TR) approach. However, the safety of the TU procedure when ipsilateral radial artery occlusion occurs is unknown.We retrospectively reviewed 87 TU cases with ipsilateral radial artery occlusion confirmed by a forearm angiogram. Eighty percent of these patients had a history of ipsilateral radial artery cannulation or surgery. We avoided the use of over-sized sheaths or applied a sheathless approach during surgery.No ulnar artery occlusion was observed by subsequent Doppler ultrasound or pulse oximetry. No patient developed hand ischemia or serious complications requiring surgery or blood transfusion during the follow-up period of 32.2 ± 24.0 months. Review of the preprocedural forearm angiograms showed that 95.7% of the patients possessed significant collaterals supplying flow from the interosseous artery to the occluded radial artery remnant. Thus, the blood circulation to the palmar arch and digital vessels was maintained even when the ulnar artery was temporarily occluded by an in-dwelling ulnar arterial sheath.TU catheterization was safe in patients with coexisting ipsilateral radial artery occlusions and feasible for use in complex intervention procedures. Cautious manipulation of ulnar artery cannulation and hemostasis helped decrease the risk of hand ischemia. ( and intervention is superior to the transbrachial and transfemoral approaches, with a lower complication rate and better patient tolerance.1,2) Ulnar artery cannulation has anatomical advantages similar to those of radial artery cannulation, such as an easier approach to the wrist portion and better patient compliance for hemostasis. Although there is less anatomical variation and vasospasm in the ulnar artery than in the radial artery, its deeper location and nearby ulnar nerve increases the difficulty of puncture and complication rate.3) To investigate the safety of transulnar (TU) coronary catheterization, limited randomized trials have compared the major adverse cardiovascular (CV) events and major vascular complications between the radial and ulnar artery approaches.4-7) The TU approach has success rates for arterial puncture and coronary intervention similar to those of the TR approach without increasing entry site complications, including arterial occlusion. However, Hahalis, et al have reported not only the relative inferiority of the cross-over rate in the TU access route but also significantly higher puncture trials, longer puncture and fluoroscopy times, and higher amounts of contrast medium in TU patients than in TR patients. 6) Thus, the ulnar artery is recommended as an alternative access site only if the radial arterial approach fails or is not feasib...

Safety of Reversing Anticoagulation by Protamine Following Elective Transfemoral Percutaneous Coronary Intervention in the Drug-Eluting Stent Era

“…[1][2][3] The access site is an important determinant of bleeding complications following PCI, 4) and the incidence of bleeding complications is significantly lower in transradial PCI than in transfemoral PCI. 5) Although radial arteries have been widely used in current PCI, including primary PCI, 6) transfemoral PCI remains necessary for complex PCI requiring a !7 Fr guide system such as chronic total occlusion or severely calcified lesions.…”

Choosing the vascular access in interventional cardiology: evolution and contemporary practice

“…The pre-procedure angiographic review of the forearm showed that 95.7% of the patients had significant collaterals from the interosseous artery to the distal portion of the radial artery, after the occlusion segment. Thus, blood circulation in the palmar arch and digital vessels was maintained even with the ulnar artery temporarily occluded by the ulnar arterial sheath (33).…”

Drep í fingrum í kjölfar ísetningar slagæðaleggja - sjúkratilfelli

“…Sýnt hefur verið fram á með allmörgum rannsóknum að almennt er öruggt að fá aeðaaðgang í ölnarslagaeð þegar sveifarslagaeð er stífluð en þessar rannsóknir hafa oftast verið á sjúklingum sem gangast undir kransaeðaþraeðingu. 3,4 Í flestum skráðum tilfellum þar sem sjúklingar hafa fengið blóðþurrðardrep í tengslum við slagaeðaleggi er um að raeða fjölveika gjörgaeslusjúklinga í lostástandi og er dánartíðni há. 2,[5][6][7][8] Áhaettuþaettir fyrir blóðþurrð eftir slagaeðaleggsísetningu eru óljósir.…”