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

Abstract

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.

Bilateral Percutaneous Ulnar Artery Approach for Retrograde Chronic Total Occlusion Intervention

“…This could be explained by the dual blood supply in the hand and the presence of extensively recruited collaterals, even without evaluation of deep palmar arch integrity by the inverse Allen's test as reported by De Andrade. 8) A similar case report of ulnar artery catheterization in an occluded radial artery has been reported by Lanspa.…”

Sheathless transulnar versus standard femoral arterial access for percutaneous coronary intervention on bifurcation lesions

“…small diameter, radial loops, pre-existing stenoses, etc. ); hence, the transulnar access route (TUA) has been introduced as an alternative upper extremity arterial access [4,5]. The combination of TUA and sheathless guiding catheters has been shown by this group to be safe and feasible for performing rotational atherectomy, even with large-bore burrs (≥2.00 mm) [6].…”

Feasibility and safety of transulnar access for performing rotational atherectomy

“…Additionally, radial access increases patient comfort and gives the opportunity for early discharge, potentially reducing the costs of hospital stay [4]. However, mainly due to anatomical reasons, transradial access is not always feasible; the transulnar approach (TUA) has been used as an alternative upper extremity arterial access [5][6][7][8]. In patients with lesions requiring debulking, rotational atherectomy has emerged as an effective modality to perform successful coronary interventions, requiring large-bore catheters and introducer sheaths.…”