Percutaneous ulnar artery approach for coronary angiography: A preliminary report in nine patients

Terashima, Minoru; Meguro, Takeshi; H, Takeda; Endoh, Norio; Ito, Yuko; Mitsuoka, Mikio; Ohtomo, T; Murai, Osamu; Fujiwara, Satomi; Honda, Hidehiko; Miyazaki, Yasusuke; Kuhara, Ryoji; Kawashima, Osamu; Isoyama, Shogen

doi:10.1002/ccd.1192

Cited by 50 publications

(40 citation statements)

References 9 publications

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“…The theoretical concern for permanent nerve trauma arises from the ulnar artery-to-nerve anatomic proximity and the difficult arterial access in many patients. This study substantially extended the limited information on this topic [4][5][6][7][8][9][10][11] and suggests that ulnar nerve palsy is unlikely after transulnar cannulation.…”

Section: The Ulnar Arterysupporting

confidence: 52%

“…In turn, this anatomic advantage of the radial artery has been associated with less local hemorrhagic complications and possibly more favorable long-term outcome. [1][2][3] The ulnar artery is rarely selected for coronary procedures in the context of a primary angiographic strategy, [4][5][6][7][8][9][10][11] despite the following potential advantages of the transulnar access:…”

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confidence: 99%

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Transulnar Compared With Transradial Artery Approach as a Default Strategy for Coronary Procedures

Hahalis

Tsigkas

Xanthopoulou

et al. 2013

Circ: Cardiovascular Interventions

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Ιnvestigations focusing on the ulnar artery as a workhorse tool for coronary procedures have shown either low Background-The ulnar artery is rarely selected for coronary angiography or percutaneous coronary intervention despite the expanding use of the transradial approach. We aimed to establish noninferiority of a default transulnar relative to transradial approach in terms of feasibility and safety. Methods and Results-This was a prospective, randomized, multicenter, parallel-group study involving 902 patients at 5 sites eligible to undergo diagnostic coronary angiography and percutaneous coronary intervention. Patients were randomized in a 1:1 ratio to either transradial approach (reference intervention) or transulnar approach (experimental intervention) regardless of the Allen test results. The primary end point was a composite of cross-over to another arterial access, major adverse cardiovascular events, and major vascular events of the arm at 60 days. The study was prematurely terminated after the first interim analysis because of inferiority of the transulnar approach. Although the difference in the primary end point became inconclusive after adjustment for operator clustering (24.30%; 99.99% confidence interval [CI], −7.98% to 56.58%; P=0.03 at α=0.0001), need for cross-over in the transulnar group remained inferior to transradial access site with a difference of 26.34% (95% CI, 11.96%-40.69%; P=0.004). Conclusions-As a result of higher cross-over rates, a first-line transulnar strategy was proven inferior to the transradial approach for coronary procedures. At present, the transulnar route should not be regarded as an acceptable alternative to the transradial access site. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01364532. (Circ Cardiovasc Interv.2013;6:252-261.)

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Section: The Ulnar Arterysupporting

confidence: 52%

mentioning

confidence: 99%

Transulnar Compared With Transradial Artery Approach as a Default Strategy for Coronary Procedures

Hahalis

Tsigkas

Xanthopoulou

et al. 2013

Circ: Cardiovascular Interventions

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“…Case series with varying number of patients [6][7][8][9] followed up with ultrasound examinations, the largest of which involved 172 patients [10] have shown that the Trans ulnar approach is an additional option when the radial artery access is not available. This technique is associated with low incidence of major vascular complications.…”

Section: Discussionmentioning

confidence: 99%

Trans Ulnar Approach for Unprotected Left Main Coronary Artery Disease

Gokhroo¹,

Sk²,

Aujayeb³

et al. 2017

J Clin Exp Cardiolog

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“…The ulnar artery mean diameter was 2.7 6 ± 0.42 mm that could be larger or smaller than the radial artery branching from the same branchial artery or even reported to be similar in size. 4,5,[11][12][13] Via a TU approach, 4 and 5 French sheaths and catheters were used for diagnostic purposes in most of the cases. 6F sheaths were needed in 46%, when demanding techniques such as the kissing balloon technique, intravascular ultrasound, and rotational atherectomy, with high success and low complication rates.…”

Section: )mentioning

confidence: 99%

Bilateral Percutaneous Ulnar Artery Approach for Retrograde Chronic Total Occlusion Intervention

Hussein¹,

Gan

Fang

et al. 2010

Int. Heart J.

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SummaryThe transradial approach for coronary diagnostic and therapeutic interventions is a well-established, safe, and effective technique that has shown a success rate comparable to that of the transfemoral approach for chronic total occlusion (CTO) with less access site complications. Recently, the transulnar approach was also found to be a safe and feasible alternative for diagnostic and percutaneous coronary intervention (PCI). There is limited data on the efficacy and safety of the transulnar approach for CTO PCI. Here, we report the case of a patient who underwent coronary intervention for CTO via the bilateral ulnar approach. (Int Heart J 2010; 51: 137-140) Key words: Ulnar, Chronic total occlusion, Retrograde intervention T ransradial coronary intervention (TRI) has become a worldwide popular approach, with increasing data showing its safety and efficacy are comparable to those of standard transfemoral intervention (TFI). The advantages of TRI include relatively lower access site complications, early mobilization, and hence shortening of hospital stay.1) With the advancement of miniaturized percutaneous coronary intervention (PCI) devices, forearm vascular access, and operator experience, TRI is also now being used for more complex lesions.Chronic total occlusion (CTO) occurs in approximately 30-50% of all patients with significant coronary stenosis who have undergone coronary angiography.2) In a recent study, TRI was found to be comparable to TFI with respect to in-hospital major adverse cardiac events (MACE).3) However, radial artery (RA) access still has certain limitations such as the relatively smaller vessel size, higher incidence of vasospasm, and presence of some anatomical variations of RA (eg, radial loop, RA access originating from high brachial or axillary arteries). In such patients, the transulnar (TU) approach may provide a reasonable alternative, but TU had not received that much attention until it was reported in 2001.4) The TU approach was then compared to the transradial (TR) approach, which was found to be a safe and effective alternative with a high success rate and low access site complications. 5) In our literature search, we could not find any reports on TU for CTO intervention. Here, we report the case of a patient who underwent the bilateral TU retrograde approach for long CTO at the distal right coronary artery (RCA). Case ReportA 71-year-old man with a history of diabetes, hypertension, and hyperlipidemia presented with stable angina on regular medication. He was admitted for elective PCI for a totally occluded RCA. History of PCI included Taxus Liberte stenting (Taxus

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Percutaneous ulnar artery approach for coronary angiography: A preliminary report in nine patients

Cited by 50 publications

References 9 publications

Transulnar Compared With Transradial Artery Approach as a Default Strategy for Coronary Procedures

Transulnar Compared With Transradial Artery Approach as a Default Strategy for Coronary Procedures

Trans Ulnar Approach for Unprotected Left Main Coronary Artery Disease

Bilateral Percutaneous Ulnar Artery Approach for Retrograde Chronic Total Occlusion Intervention

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