Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center

Abstract

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.

Complications Associated with Transulnar Approach in Patients undergoing Percutaneous Coronary Interventions

“…We found minor bleeding in 28 (23.7%) patients followed by ulnar artery occlusion, excessive bleeding, ulnar nerve injury and hematoma in 10 (8.5%), 8 (6.8%), 6 (5.08%) and 2 (2.5%) patients respectively. These results were comparable to some previous studies [18][19][20][21][22][23].…”

“…In our study we found that 76 (64.41%) patients had stable angina, 26 (22.03%) patients had unstable angina and 16 (13.56%) patients had STEMI. These results were comparable to the studies previously conducted [17][18]. In this study we found no major complications associated to transulnar approach.…”

Transulnar versus Transradial Approach for Percutaneous Coronary Procedures

“…While, in the previous study 2020 (8) , the mean fluoroscopy time in the ulnar group was 5.6 ± 1.9 min for CA and 12.4 ± 2.6 min for PCI, whereas in the radial group it was 5.3 ± 2.1 min for CA and 11.9 ± 2.3 min for PCI. However, none of these differences reached statistical significance (p > 0.05).…”

“…Heparin and intraarterial vasodilators (nitroglycerin and verapamil) were administered, in addition to cardiac catheterization. Following catheterization, the sheath was extracted, and a compressive dressing was utilized to achieve hemostasis (8) . Ulnar Artery Puncture Variations: When ulnar artery pulsations are weak but palpable at the distal wrist, it is considered safe to indentify the ulnar artery further distally, at the level of skinfolds over the carpal bones.…”

Novel usage of everolimus-eluting coronary stent for intracranial atherosclerotic disease: a technical report and case series

“…While there have not been many studies comparing trans-ulnar with trans-radial approach, a trans-ulnar approach is described as an alternative to trans-radial access 20. In randomized studies for coronary interventions, complication risks using trans-ulnar access were found to be close to trans-radial access 21 22. Therefore, success in deploying the Xience Skypoint using three different approaches demonstrate the stent’s flexibility, which gives providers the ability to perform their cases in a way that will be most beneficial to their patients.…”