E-134 Trans-ulnar access for neurointervention: pushing the boundaries of arterial access

Abstract

Background Transradial access has been gaining popularity in neurointerventional surgery. Failure to obtain radial access may lead neurointerventionists to convert to a transfemoral approach, which is associated with a higher complication rate than the radial approach. Ulnar access, however, provides a similar safety profile to radial access and permits neurointerventionists to work in the same hand without having to convert to a femoral approach. In this study, we evaluate the feasibility of using transulnar access to perform diagnostic cerebral angiograms and various neurointerventional procedures. Methods Consecutive patients who underwent transulnar diagnostic angiogram or neurointerventional procedures were included in the study over a period of 12 months. Data on demographics, procedure indication, devices, technique and complications recorded. A descriptive analysis was carried out. Results Transulnar access was utilized in 18 patients over the study period. Mean age was 71.6 + 6.8 years; 10 (55.5%) patients were male. Fifteen diagnostic angiograms and 3 neurointerventions (1 left middle meningeal artery, 1 right carotid artery stenting, 1 left carotid artery stenting) were performed. All the procedures were performed using a right sided ulnar artery with ultrasound guidance. The indications for ulnar access included a feeble radial artery pulse (n=17), or radial artery occlusion due to prior angiogram (n=1). A 5 Fr sheath was used for diagnostic procedures while 6 Fr was used for neurointerventions. A TR band was used for closure. No case required conversion to femoral access. No access related complication was noticed. Conclusion Transulnar arterial access is safe and feasible for diagnostic and interventional neuroangiography procedures and provides a useful alternative to transradial access, potentially avoiding complications associated with transfemoral access. Disclosures R. Dossani: None. M. Waqas: None. M. Tso: None. G. Rajah: None. F. Chin: None. A. Yunke: None. A. Siddiqui: None. J. Davies: None.