Same wrist intervention via the cubital (ulnar) artery in case of radial puncture failure for percutaneous cardiac catheterization or intervention: The multicenter SWITCH registry

PurposeOur aim was to evaluate the acute success and complication rates of the transradial and transulnar access for iliac artery stenting using sheathless guiding systems.MethodsClinical and angiographic data from 156 consecutive patients with symptomatic iliac artery stenosis who were treated with transradial or transulnar access were evaluated. All patients underwent Duplex ultrasound before and after the intervention. The primary endpoints were the procedural success rate, major adverse events, and access site complication rates. The secondary endpoints were the angiographic result of the iliac artery intervention, fluoroscopy time, X‐ray dose, procedure length, crossover rate to another puncture site and hospitalization duration. The impact of the learning curve was also investigated, along with right or left radial access.ResultsThe indication for the intervention was intermittent claudication in 109 patients (69.9%), critical limb ischemia in 44 (28.2%) subjects and acute limb ischemia in three individuals (1.9%). Technical success was achieved in 155 patients (99.4%), with a crossover rate of 3.8%. Radial and ulnar artery access was used in 151 (96.8%) and 7 (4.5%) patients, respectively. The Ankle‐brachial index increased from 0.69 [0.65–0.72] to 0.91 [0.88–0.95] as a result of the procedures (P < 0.001). The cumulative incidence of major adverse events was 3.8% at the 2‐month follow‐up (0% in patients with intermittent claudication and 13.8% in patients with critical limb ischemia). Radial artery access site complications were encountered in eight patients (5.1%). We documented decreased X‐ray doses (1742.0 [783.9–2701] vs. 1435 [991.1–1879] vs. 692.8 [275.3–1110] Gy cm−2 P < 0.05) over time; however, the fluoroscopy time, procedure time, and contrast consumption were not significantly different. Left hand access was not associated with significantly better results than right radial artery access.ConclusionsIliac artery stenting can be safely and effectively performed using radial or ulnar artery access and sheathless guiding catheters, with acceptable complication rates and high levels of technical success. The physician learning curve plays an important role in decreasing the X‐ray dose. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Section: Discussionmentioning

confidence: 99%

Transradial and transulnar access for iliac artery interventions using sheathless guiding systems: A feasibility study

Ruzsa

Tóth

Nemes

et al. 2016

“…An initial learning curve will probably exist for novice ulnar operators, so it may be prudent to begin with elective and stable patients vs. STEMI. In cases of failed radial access or catheterization, performing ipsilateral ulnar access can be considered based upon the SWITCH study .…”

Section: Discussionmentioning

confidence: 99%

“…In the same wrist intervention via the cubital (ulnar) artery in case of radial puncture failure for percutaneous cardiac catheterization or intervention: the multicenter SWITCH registry of 1702 patients, ipsilateral ulnar catheterization was performed after either failed radial access or catheterization in 5 European centers (117 failed radial [6.9%]; 42 ulnar cases attempted, 36 successful cannulations [85.7%], 33 successful cases [78.6%]). The results showed that ipsilateral ulnar catheterization and PCI can be safely performed without symptomatic hand ischemia (5 experienced radial operators, >50% radial procedures).…”

Section: Methodsmentioning

confidence: 99%

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Transulnar cardiac catheterization and percutaneous coronary intervention: techniques, transradial comparisons, anatomical considerations, and comprehensive literature review

Kar

2017

Ulnar arterial access for cardiac catheterization and intervention is an alternative approach compared with radial or femoral access. Ulnar access is infrequently performed since the radial artery is readily palpable and is commonly used worldwide to minimize vascular complications from femoral access. Nevertheless, ulnar access provides a suitable access site in patients who are poor candidates for femoral access, have pre-existing radial occlusion, radial artery hypoplasia or hyperplasia from prior radial artery procedures, radial stenosis, radial loops, radial tortuosity, small radial arteries, and/or have future need for radial graft for dialysis or coronary artery bypass graft. Furthermore, femoral access is the standard default option if radial access fails. Consequently, learning ulnar access provides a suitable forearm alternative to avoid femoral access when deemed high risk or undesirable. This review discusses the techniques of ulnar access, advantages and disadvantages of ulnar versus radial access, the clinical trials on ulnar cardiac catheterization and its associated complications.

“…However, transradial access (TRA) is unsuccessful in up to 7% of patients, primarily due to the inability of accessing the radial artery or failure of advancing a catheter to the ascending aorta, resulting in crossover to another arterial access site [1,3]. Although access crossover to the contralateral radial artery or the femoral artery is commonly recommended following TRA failure, recent data from large registries and randomized trials indicates that the ipsilateral transulnar approach may represent a reasonable alternative for the performance of coronary procedures [4,5]. In this report, we describe two cases of successful ipsilateral ulnar artery access after TRA failure and a novel technique to achieve simultaneous hemostasis of the ipsilateral radial and ulnar access sites.…”

Section: Introductionmentioning

confidence: 99%

A novel technique for simultaneous hemostasis of ipsilateral radial and ulnar artery access sites

Roberts

Niu

2017

With the increased use of transradial artery access (TRA) for diagnostic and coronary interventional procedures, crossover to the ipsilateral ulnar artery after TRA failure is being reported more frequently. A major challenge with ipsilateral transradial and ulnar artery access is achieving efficient patent hemostasis of both the radial and ulnar arteries at the completion of the procedure. In this report, we describe two cases of failed TRA with subsequent ipsilateral ulnar artery access. A novel and practical technique of simultaneous patent hemostasis of both the ipsilateral radial and ulnar artery access sites is described, using a QuikClot Radial hemostasis pad and a TR Band .