Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route

Single centre experience

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

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: To assess the feasibility and safety of transulnar approach whenever transradial access fails. Background: Radial access for coronary procedures has gained sound recognition. However, the method is not always successful. Methods: Between January 2010 and June 2013, diagnostic with or without percutaneous coronary intervention (PCI) was attempted in 2804 patients via the radial approach. Transradial approach was unsuccessful in 173 patients (6.2%) requiring crossover to either femoral (128 patients, 4.6%) or ulnar approach (45 patients, 1.6%). Patients who had undergone ulnar approach constituted our study population. Selective forearm angiography was performed after ulnar sheath placement. We documented procedural characteristics and major adverse cardio-cerebrovascular events. Results: Radial artery spasm was the most common cause of crossover to the ulnar approach (64.4%) followed by failure to puncture the radial artery (33.4%). Out of 45 patients (82.2%), 37 underwent successful ulnar approach. The eight failed cases (17.8%) were mainly due to absent or weak ulnar pulse (75%). PCI was performed in 17 cases (37.8%), of which 8 patients underwent emergency interventions. Complications included transient numbness, non-significant hematoma, ulnar artery perforation, and minor stroke in 15.5%, 13.3%, 2.2% and 2.2%, respectively. No major cardiac-cerebrovascular events or hand ischemia were noted. Conclusion: Ulnar approach for coronary diagnostic or intervention procedures is a feasible alternative whenever radial route fails. It circumvents crossover to the femoral approach. Our study confirms satisfactory success rate of ulnar access in the presence of adequate ulnar pulse intensity and within acceptable rates of complications.

Original languageEnglish
Pages (from-to)138-144
Number of pages7
JournalJournal of the Saudi Heart Association
Volume26
Issue number3
DOIs
Publication statusPublished - 2014

Fingerprint

Radial Artery
Percutaneous Coronary Intervention
Thigh
Pulse
Ulnar Artery
Hypesthesia
Spasm
Punctures
Forearm
Hematoma
Angiography
Emergencies
Ischemia
Hand
Stroke
Safety
Population

Keywords

  • Alternative
  • Coronary procedures
  • Feasible
  • Femoral approach
  • MACCE
  • Radial
  • Ulnar

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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.

In: Journal of the Saudi Heart Association, Vol. 26, No. 3, 2014, p. 138-144.

Research output: Contribution to journalArticle

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abstract = "Objectives: To assess the feasibility and safety of transulnar approach whenever transradial access fails. Background: Radial access for coronary procedures has gained sound recognition. However, the method is not always successful. Methods: Between January 2010 and June 2013, diagnostic with or without percutaneous coronary intervention (PCI) was attempted in 2804 patients via the radial approach. Transradial approach was unsuccessful in 173 patients (6.2{\%}) requiring crossover to either femoral (128 patients, 4.6{\%}) or ulnar approach (45 patients, 1.6{\%}). Patients who had undergone ulnar approach constituted our study population. Selective forearm angiography was performed after ulnar sheath placement. We documented procedural characteristics and major adverse cardio-cerebrovascular events. Results: Radial artery spasm was the most common cause of crossover to the ulnar approach (64.4{\%}) followed by failure to puncture the radial artery (33.4{\%}). Out of 45 patients (82.2{\%}), 37 underwent successful ulnar approach. The eight failed cases (17.8{\%}) were mainly due to absent or weak ulnar pulse (75{\%}). PCI was performed in 17 cases (37.8{\%}), of which 8 patients underwent emergency interventions. Complications included transient numbness, non-significant hematoma, ulnar artery perforation, and minor stroke in 15.5{\%}, 13.3{\%}, 2.2{\%} and 2.2{\%}, respectively. No major cardiac-cerebrovascular events or hand ischemia were noted. Conclusion: Ulnar approach for coronary diagnostic or intervention procedures is a feasible alternative whenever radial route fails. It circumvents crossover to the femoral approach. Our study confirms satisfactory success rate of ulnar access in the presence of adequate ulnar pulse intensity and within acceptable rates of complications.",
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