TransRadial versus transUlnar artery approach for elective invasive percutaneous coronary interventions: a randomized trial on the feasibility and safety with ultrasonographic outcome – RAUL study

Abstract

Introduction Transradial access (TRA) for coronary angiography (CAG) and percutaneous coronary intervention (PCI) is superior to transfemoral access (TFA). Transulnar access (TUA) is an alternative to TRA. Aim To compare the efficacy and safety of TRA vs. TUA in patients scheduled for CAG or PCI. Material and methods This was a prospective, single-center, randomized study conducted between 2013 and 2016. Two hundred patients referred for the first elective CAG were included in the study. Eligible patients were then randomly assigned to the TRA or TUA group. Before and after the invasive procedure, all patients underwent ultrasonographic measurements of the right upper limb arteries. Results The primary endpoint was efficacy, defined as a successful CAG without a crossover of vascular access. The secondary endpoint was safety, assessed as the number of vascular complications. Successful coronary angiography via the access site was 95% vs. 75% in the TRA vs. TUA groups, respectively ( p < 0.001). It depended on the anatomy of UA and the operator experience. No differences were observed in early and late follow-up complications. Conclusions TRA was superior to TUA with regard to efficacy. TUA occurred a safe approach for CAG and PCI and could be used as an alternative method of forearm access.

Complications Following Ulnar Artery Catheterization for Coronary Angiography

“…This may exemplify prior research that has found a steeper learning curve when using ulnar artery access due to the artery's depth, weak palpability, and anatomical location close to the ulnar nerve. 3,5 In institutions where ulnar artery access is rarely performed, complication rates may be higher due to lack of training and exposure to the technique.…”

“…3,4 Ulnar artery catheterization has also gained recent popularity due to the perceived benefit it is larger, has a straighter course, and is less prone to vasospasm. 3,5 However, this also presents with potential risks as post catheterization occlusion of the ulnar artery may be less well tolerated. The ulnar artery tends to contribute more to the superficial palmar arch, and studies have shown the superficial arch contributes more blood flow to the digital arteries.…”

“…Ulnar artery catheterization was considered to have a steeper learning curve given the depth of artery and weak palpability on examination. 3,5 Studies have shown that ulnar artery catheterization has been associated with an increased number of punctures and a higher crossover rate to alternative access site when compared with the radial artery. [7][8][9] Although the incidence of complications following radial artery catheterization has been more thoroughly examined, only a few large series and case reports have been published on the incidence of complications after ulnar artery access specific to coronary angiography.…”

Forearm compartment syndrome after a trans-ulnar coronary intervention in a patient with ST segment elevation myocardial infarction

“…The trans-ulnar approach (TUA) for cardiac catheterization is an attractive option for experienced operators who are skilled in this technique, especially in cases of anatomic variations of the radial artery or weak radial pulses [1][2][3] and has been associated with fewer bleeding complications. 4 Compartment syndrome is a rare but hand-threatening complication of trans-radial approach (TRA).…”

A narrative review of history, advantages, future developments of the distal radial access

“…[3][4][5][6] RA also has advantages over ulnar access (UA). 7 However, some researchers still consider the ulnar artery a possible alternative to the radial artery (RadA) because of the relationship between the diameter of the artery and the weakening of the hand compressive force according to dynamometry data. 8 For the last 10 years, due to improvements in endovascular instrumentation and an increase in the manual skills of surgeons, RA has been actively used to treat pathologies in the peripheral arteries 9 and pelvic organs 10 and in neurointervention.…”