Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: Systematic review and meta‐analysis

Fernandez, Ritin; Zaky, F.; Ekmejian, A.; Curtis, Elizabeth; Lee, A.

doi:10.1002/ccd.27479

Cited by 43 publications

(42 citation statements)

References 20 publications

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“…We started the arterial puncture on the lateral side of the ulnar artery to reduce pain and spasm approximately 0.5 to 3 cm proximal to the flexor crease skinfold along the axis with the most powerful pulsation of the artery. The needle was inserted at a 45°-to-60°angle along the vessel axis and from lateral to medial, avoiding the ulnar nerve (Fernandez R et al, 2018). Using 6F Kits used routinely for radial sheaths (SCW-TIS, England & Callisto, Netherlands) the Seldinger technique was applied by passing a 0.021-in hydrophilic guidewire through the needle and after removing the needle, passing a 6-Fr hydrophilic sheath over the guidewire; vasodilators nitroglycerin (100 μg) and verapamil (2.5 mg) and heparin (50-70 IU/kg, up to 5000 U) were administered intra-arterially.…”

Section: Methodsmentioning

confidence: 99%

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: Methodsmentioning

confidence: 99%

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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“…In a meta‐analysis of six trials in 2018 (5,299 patients) by Fernandez et al, ulnar versus radial access showed no significant difference in major adverse cardiac events, complications, arterial access time, fluoroscopy time, or contrast load. However, in another meta‐analysis from 2016 (five trials, 2,744 patients) by Dahal et al, ulnar showed increased puncture rates and access crossover with similar safety (complications) and efficacy as radial.…”

Section: Discussionmentioning

confidence: 96%

“…In a prospective single center study of 636 patients (317 ulnar; radial 319) by Liu et al, ulnar access showed similar results and complications to radial, so that it was safe for the treatment of acute coronary syndrome. Moreover, a recent meta‐analysis showed no difference in complications between standard radial and ulnar access for cardiac catheterization . Ulnar artery occlusion occurs in 1.9% .…”

Section: Discussionmentioning

confidence: 99%

Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization

Kar

2019

Cathet Cardio Intervent

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The femoral and radial arteries are the standard access routes for cardiac catheterization. In cases where the right radial artery has been previously utilized or is not suitable for repeat procedures, the left dorsal distal radial artery (anatomical snuff box) or the ulnar artery may be an alternative access site. In this systematic review, alternative access sites are described along with the techniques of cannulation, technical considerations, ultrasound imaging, clinical studies, and their complications. As we routinely perform more radial procedures, increased complications will arise, so it becomes important to gain expertise in alternative access for future coronary interventions. Such a systematic review has not been previously published so it will enhance the reader's knowledge of alternative access.

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“…The ulnar artery has been shown to be a safe alternative route for left heart catheterization [8]. It is anyway a safer route than the femoral access and is sometimes larger than the radial artery.…”

Section: Using Forearm Artery Alternatives (The Ulnar Artery or The Lmentioning

confidence: 99%

Minimally Invasive Cardiology for Everyone: Challenging the Transradial Access

Dangoisse¹

2019

Angiography

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Transradial access is now well established as the safest route for percutaneous coronary intervention. Nevertheless, its use is often restricted to "easy" cases, switch to the transfemoral route being too rapidly advocated/mandated. We will discuss the different challenges associated with a "TRA for everybody" strategy. (1) The vascular access per se is challenging. TRA failure is most of the time an operator failure to cannulate this vessel. There are some ways to overcome the technical problems and to improve the operator skill and his success rate. (2) TRA is systematically denied for some patient populations: patients with previous coronary artery bypass graft surgery are particularly at risk of not being catheterized by TRA despite excellent performance of this route for diagnostic or intervention. In the same way, MI patients in unstable condition are also at risk to be catheterized by TFA although, most of the time, their condition is addressable through TRA and will largely benefit from this route. (3) Frailty and small body-sized ill patients are also at risk of TFA for PCI when proximal coronary artery disease must be treated. There are alternatives to the use of large and very large catheters for treatment of proximal coronary artery disease. (4) The radial occlusion is a manageable problem, with simple and effective solutions.

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Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: Systematic review and meta‐analysis

Abstract: There is evidence to support safe use of the ulnar artery as an alternative to the radial artery for access for cardiac catheterization.

Cited by 43 publications

References 20 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

Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization

Minimally Invasive Cardiology for Everyone: Challenging the Transradial Access

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