Abstract
BackgroundTrans-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.AimThis 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.ResultsVascular 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.ConclusionOur 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.
Highlights
Trans-ulnar approach was proposed primarily for elective procedures in patients not suitable for trans-radial approach that was introduced two decades ago
We included 120 patients who continued to do Doppler study coming for coronary Coronary angiography (CA) or Percutaneous coronary intervention (PCI) at our catheterization laboratory (Cath lab); patients were distributed randomly for each vascular access; procedures were performed by our staff members; and patients fell in two groups as follow: 80 patients in the radial group and 40 patients in the ulnar group
Our study included 120 patients coming for CA or PCI (including patients planned for PCI and ad hoc PCI as ST elevation myocardial infarction (STEMI) patients); patients were distributed randomly for each vascular access, the procedures were performed by our staff members, and the primary access was as follow: 80 patients in the radial group and 40 patients in the ulnar group
Summary
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. Trans-radial approach (TRA) PCI was introduced two decades ago [1]. Trans-ulnar approach had been proposed for elective procedures in patients not suitable for trans-radial approach. The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: radial, femoral, brachial, ulnar, subclavian, and axillary arteries and even direct puncture of the aorta from a translumbar approach, have been utilized in the past [4]. Terashima et al [6] were the first who recorded the feasibility of trans-ulnar approach for diagnostic catheterization of coronary arteries about two decade ago, and their study was followed by limited numbers of investigations later [5]. Vasospasm is less likely to happen than in radial procedures given less alpha receptors in the ulnar artery [8]
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