The initial experience of 2495 cases of the ulnar artery as default access for coronary diagnostic and interventional procedures at a single center: An observational study

Abstract

Introduction Upper limb arterial access is being increasingly used for coronary diagnostic and intervention procedures. Radial artery access is associated with reduced morbidity and mortality as compared to femoral artery access. However, access to the radial artery is not always successful with reported crossover rates to other routes between 3% and 8%. Ulnar artery access is emerging an attractive option both as upfront access and rescue access in case of failure to obtain radial artery access. Aims - To assess and document the feasibility and safety of ulnar access as a default strategy. Methods 2654 patients planned for coronary diagnostic and intervention procedureswere assessed for inclusion. Inclusion criteria were, all patients planned for coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpable ulnar pulse. Exclusion criteria included reverse Barbeau test type D, previous procedure resulting in radial artery occlusion/excision, hemodialysis patients having ipsilateral AV fistula and severe forearm deformities. Results 2525 patients were found eligible, out of which 2495 (98.81%) were successfully cannulated. Procedure was completed in 2414 patients. Local site bleeding in 40 (1.6%) and acute loss of ulnar pulse noted in 33 (1.3%) out of 2495 patients. None of the patients had gangrene of access site, pseudo-aneurysm, arteriovenous fistula or neurological deficit post procedure. Conclusion The Ulnar artery access as a default access is safe and feasible option for patient undergoing coronary diagnostic and interventional procedures.

Iatrogenic arteriovenous fistula in the brachial artery after percutaneous coronary intervention in a patient with end stage kidney disease

“…3 In addition, brachial arterial access is widely used for CAG and PCI procedures, because it is associated with reduced morbidity and mortality that result from complications compared to femoral arterial access. 4 Iatrogenic AVF is one of complications that accompanies venous and arterial puncture, and mainly occurs at the level of the femoral access. Iatrogenic AVF in the brachial artery is not rare, 5,6 Iatrogenic arteriovenous fistula in the brachial artery after percutaneous coronary intervention in a patient with end stage kidney disease but it tends to close spontaneously and disappear within a few years of its onset.…”