Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience

Sallam, Mansour; Al-Riyami, Adil; Misbah, Mohammad; Al-Sukaiti, Rashid; Al-Alawi, Abdallah; Al-Wahaibi, Aiman

doi:10.1016/j.jsha.2014.01.003

Cited by 7 publications

(9 citation statements)

References 17 publications

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“…It is worth mentioning that 5 cases out 7 failed ulnar puncture were among the first 10 cases randomized to ulnar arm reflecting also the progress in our operators’ learning curve. These outcomes are similar to Sallam et al [ 13 ] who stated that the main reason for ulnar access failure was the inability to puncture (17.7%).…”

Section: Discussionsupporting

confidence: 88%

“…It is worth mentioning that 5 cases out 7 failed ulnar puncture were among the first 10 cases randomized to ulnar arm reflecting also the progress in our operators' learning curve. These outcomes are similar to Sallam et al [13] who stated that the main reason for ulnar access failure was the inability to puncture (17.7%). Transient ulnar artery spasm occurred in 1 case only in the ulnar group (2.5%), while persistent radial artery spasm occurred in 4 cases (5%) in the radial group, and the radial, more than the ulnar spasm, was statistically significant.…”

Section: Discussionsupporting

confidence: 87%

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Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center

2020

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Background Trans-ulnar approach was proposed primarily for elective procedures in patients not suitable for trans-radial approach that was introduced two decades ago. The trans-ulnar approach is as safe and effective as the trans-radial approach for coronary angiography and intervention. Aim This study’s aim was to assess the feasibility and safety of the trans-ulnar approach in coronary procedures as a preliminary experience for operators experienced in trans-radial approach with no/minimal trans-ulnar approach experience at an Egyptian center. Results Vascular access in 120 patients was selected randomly for coronary angiography and angioplasty—80 through radial and 40 through ulnar approach. Patients were examined for local complications and Doppler evaluation to both radial and ulnar arteries a day after the procedure was done. Ulnar approach success was 82.5% versus 93.7% in the radial group; failure of ulnar artery puncture was the only cause of crossover in the ulnar group, while occurrence of persistent spasm was the leading cause of crossover in the radial group followed by radial artery tortuosity. The procedure time of coronary angiography and percutaneous coronary intervention of the ulnar group was significantly higher than that of the radial group (P value = 0.011 and 0.034, respectively). The mean caliber of the right ulnar artery was 2.45 ± 0.38, slightly larger than that of the radial artery 2.33 ± 0.38 at the level of the wrist, but this difference was statistically non-significant. Conclusion Our study demonstrated that ulnar access with experienced radial operators and in our patients is a safe and practical approach for coronary angiography or angioplasty, without any major complications. Bearing in mind its high success rate, it can be used when a radial artery is not useful for the catheterization or as a default approach on the expense of slightly longer procedural time.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center

2020

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“…Thus, TUA has been considered as secondary access site after TRA failure for either elective or emergency coronary diagnostic and interventional procedures. 3…”

Section: Introductionmentioning

confidence: 99%

The Ulnar Artery as a Favorable Primary or Alternative Access Site for Coronary Angiography and Interventions

Gündüz

Ayhan

et al. 2020

Angiology

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The transulnar approach (TUA) has been considered both as primary access and as a secondary access site after transradial access (TRA) failure for coronary invasive procedures. However, there is little evidence supporting the use of the TUA as the first approach to diagnostic coronary angiography (CAG) or interventions. Patients (n = 587) who underwent CAG and/or angioplasty (292 patients via TRA, 295 patients via TUA) were included. The primary end points of the study were major adverse cardiac events and major vascular events (hematoma, vascular occlusion, vasospasm), and secondary end points included angiographic success, crossover rate, and angiographic procedural times. The mean age was 60 ± 21 years. The composite primary end points occurred in 34 (11.6%) patients in the TRA and 22 (7.4%) patients in the TUA arm ( P < .001). More arterial occlusion and more arterial spasm than in the TUA and similar urgent target vessel revascularization were observed in the TRA group in 48 hours. Based on previous studies and our clinical experience, we speculated that the TUA performed by an experienced operator has equal status with the TRA for coronary catheterization, especially in patients with a palpable ulnar pulse.

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“…Transulnar access (TUA) is preferred as an alternative access site when the RA cannot be used or accessed . TUA is as effective and safe as TRA in coronary angiography and angioplasty .…”

Section: Introductionmentioning

confidence: 99%

“…Transulnar access (TUA) is preferred as an alternative access site when the RA cannot be used or accessed . TUA is as effective and safe as TRA in coronary angiography and angioplasty . In addition, it is also associated with low vascular complication rates, shorter length of hospital stay, low rate of patient dissatisfaction, and low mortality rates, similar to TRA when compared with the transfemoral approach .…”

Section: Introductionmentioning

confidence: 99%

Flow and Diameter Changes of Forearm Arteries During Temporary Unilateral Reciprocal Occlusion: A Prospective Observational Study

Kaplanoğlu

Beton

2017

J. Clin. Ultrasound

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Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience

Cited by 7 publications

References 17 publications

Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center

Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center

The Ulnar Artery as a Favorable Primary or Alternative Access Site for Coronary Angiography and Interventions

Flow and Diameter Changes of Forearm Arteries During Temporary Unilateral Reciprocal Occlusion: A Prospective Observational Study

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