Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization

Kar, Subrata

doi:10.1002/ccd.28398

Cited by 14 publications

(7 citation statements)

References 33 publications

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“…Transradial access (TRA), which is characterized by a low incidence of complications, such as radial artery occlusion, hematoma, spasm, etc, 1 is currently considered as the default choice in cardiac catheterization Distal radial access (dTRA), also called “snuff box” access, has gain increased interest in the field of interventional cardiology due the low incidence of complications as well as for the comfort offered to both the patient and the operator. 2,3 This increased interest in this novel vascular access has led to the publication of several reports increasing the available data on this issue, However, a comprehensive and updated comparison between conventional (cTRA) and dTRA is lacking. 4 Aim of the present study is to provide an updated comparison of the complications between dTRA and cTRA access after coronary angiography and/or PCI performing a systematic review and meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

et al. 2021

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Background: A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated. Objective: To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis. Data sources: Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively. Study eligibility criteria: Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years. Study appraisal and synthesis methods: Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, p < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31–069, p = 0.002, I2 = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37–1.13, p = 0.12, I2 = 0% and RR: 0.88, 95% CI: 0.48–1.63, p = 0.001, I2 = 0%, respectively). Limitations: Only eight case-control studies met inclusion criteria Conclusion: This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.

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Section: Introductionmentioning

confidence: 99%

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

et al. 2021

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“…They suggest that use of the dorsal distal radial artery, avoiding the volar forearm compartment, may reduce the risk of compartment syndrome in the setting of postprocedural hematoma formation. 12 Data on the safety of ipsilateral transulnar access in the setting of radial artery occlusion or previous transradial access are limited, and published guidelines do not recommend it at this time. 10 Despite that, a recent survey conducted by the American College of Cardiology Foundation found that 3% of cardiologists listed ipsilateral (described as homolateral) transulnar access as their preferred access site following failed transradial access attempt.…”

Section: Discussionmentioning

confidence: 99%

Complications Following Ulnar Artery Catheterization for Coronary Angiography

Grasso

Mclaughlin

Amendola

et al. 2022

Hand (New York, N,Y.)

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Background: Use of radial and ulnar access has increased due to its perceived benefits over femoral access. Ulnar artery catheterization can place patients at risk of significant complications, including pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve injury, and critical hand ischemia. The purpose of this study was to describe complications specific to ulnar artery catheterization. Methods: After obtaining institutional review board approval, a retrospective review was performed on all patients who underwent ulnar artery catheterization at our institution between 2019 and 2021. Complications were assessed, and complication rates were compared with previously published studies on ulnar artery catheterization for coronary angiography (percutaneous coronary intervention). Results: A total of 41 patients were available for review with a mean age of 59 years. Of these, 17 patients (41%) sustained complications in the immediate postprocedural period. These complications included hematoma (12 patients, 29%), pseudoaneurysm (1 patient, 2%), ulnar artery thrombosis (1 patient, 2%), ulnar neuropathy (3 patients, 7%), arterial damage requiring repair (2 patients, 5%), transient ischemia (3 patients, 7%), and compartment syndrome (2 patients, 5%). Three of these patients (7%) required operative intervention, and several were admitted to the hospital for an additional period of observation. Conclusions: This series highlights the significant risks associated with ulnar artery catheterization for percutaneous procedures. Complications include pseudoaneurysm, expanding hematoma, compartment syndrome, ulnar nerve damage, and critical hand ischemia. Several of these patients required urgent or emergent surgical intervention, with some patients experiencing ongoing ulnar nerve symptoms.

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“…The limitations of the transulnar approach are explained by the deeper path in the forearm, making palpation more difficult and the most laborious hemostasis as a result of the absence of compression under a rigid surface such as bone structure (28,29). Local complications can be the same through the radial approach, associating the ulnar nerve injury.…”

Section: Limitations Of the Ulnar Accessmentioning

confidence: 99%

Choosing the vascular access in interventional cardiology: evolution and contemporary practice

Duarte¹,

Lorenzo²

2021

HVT

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Percutaneous coronary diagnostic and therapeutic procedures are very frequent worldwide and therefore bring to discussion the best vascular access for each patient. The vascular access for coronary angiography or coronary interventions must be chosen according to the patient's clinical and anatomical characteristics, as well as the experience of the interventional cardiologist. Several studies have shown the superiority of radial access compared to femoral access, reducing local complications, major cardiovascular events, death and hospital costs. The ulnar approach is a feasible and safe option in the absence of radial access.

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Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization

Cited by 14 publications

References 33 publications

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

Complications Following Ulnar Artery Catheterization for Coronary Angiography

Choosing the vascular access in interventional cardiology: evolution and contemporary practice

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