Transulnar approach as an alternative access site for coronary invasive procedures after transradial approach failure

Andrade, Pedro Beraldo de; Tebet, Marden André; Nogueira, Ederlon Ferreira; Esteves, Vinícius; Andrade, Mônica Vieira Athanazio de; Labrunie, André; Mattos, Luiz Alberto

doi:10.1016/j.ahj.2012.08.001

Cited by 35 publications

(33 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Larger studies have further confirmed the safety and effectiveness of TUA as an alternative wrist approach to TRA for coronary interventions. 16,53 The procedural success, advantages and complication rates for transulnar interventions appear similar to those from the TRA. 15,53 Adding the ulnar artery access expertise could further reduce the crossover rate to TFA and lower the intrinsic risk of bleeding and vascular complications associated with the TFA.…”

Section: Ulnar Artery Accessmentioning

confidence: 67%

See 1 more Smart Citation

The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome

Kedev

2013

Interventional Cardiology Review

View full text Add to dashboard Cite

An invasive strategy including percutaneous coronary intervention (PCI) improves clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and in high-risk patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). 1,2The femoral approach (TFA) is the preferred and most widely used percutaneous access site in most cardiac catheterisation laboratories worldwide. However, being a relatively deep and terminal vessel, the femoral artery may expose the patient to frequent bleeding and vascular complications, 3,4 especially in the setting of acute coronary syndrome (ACS) where potent antithrombotic drugs are frequently used. 5,6 Since its initial description as a safe and feasible access route for cardiac catheterisation, 7,8 the transradial access (TRA) has increasingly been used for PCI. The main advantage over the TFA is a reduced risk of access site bleeding and major vascular complications, particularly in the presence of multiple and more powerful antiplatelet and antithrombotic agents.9 This is mainly ascribed to the more favourable anatomy of the radial artery that runs superficially, separated from major neurovascular structures, thus allowing shorter times to haemostasis and ambulation as compared with the TFA. 10More recently, the radial approach has been shown to confer mortality benefits for STEMI patients and a reduction in mortality, myocardial infarction (MI) and stroke for patients undergoing the procedure at high-volume radial centres. 11-13Reported access failure for radial procedures in primary PCI (PPCI) is low with an access crossover rate between 3.8 % 14 and 9.6 % 13 with negligible time delay by expert operators. There are several reasons leading to failure -inability to cannulate, severe radial artery spasm (RAS) and anatomical variations. In some of these difficult transradial cases, ulnar artery cannulation has been proposed as a reasonable and useful alternative to the TRA if performed by an experienced radial operator, before crossover to the TFA. 15,16 Bleeding Complications in Acute Coronary SyndromePeri-PCI procedural bleeding complications have been consistently associated with worse outcomes and increased short-and longterm mortality. 6,17 Access site-related bleeding, accounting for as many as 30-50 % of all causes of bleeding in patients with ACS, has repeatedly been found to be the major contributor for bleeding events. 9,[18][19][20] Due to the firm link between bleeding, ischaemic events and mortality, more attention has recently been focused on bleeding avoidance strategies.21 Despite the development of new more potent, selective and safe antithrombotics, the use of TRA remains likely the best way to significantly influence access site-related bleeding risk. [22][23][24][25] Recently, the REgistro regionale AngiopLastiche dell'Emilia-Romagna (REAL) Registry of 11,068 STEMI patients undergoing PPCI, showed that TRA was associated with a decreased two-year mortality rate compared with the traditional TFA (8.8 versus 11.4 %, hazard ratio ...

show abstract

Section: Ulnar Artery Accessmentioning

confidence: 67%

“…When the TRA is not possible or fails, the TUA may be considered as a safe alternative before reverting to the TFA. 16 The TUA is a viable option for the high-volume radial centres, when performed by the expert radial operators who are skilled in ulnar artery cannulation.…”

Section: Ulnar Artery Accessmentioning

confidence: 99%

The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome

Kedev

2013

Interventional Cardiology Review

View full text Add to dashboard Cite

show abstract

“…Several single arm studies and randomized controlled trials (RCTs) have evaluated TUA in patients undergoing coronary procedures [5,6,[11][12][13][14][15]. The RCTs that compared TUA versus TRA reached different conclusions [10,16].…”

Section: Introductionmentioning

confidence: 99%

Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta‐analysis of randomized controlled trials

Dahal

Rijal

Lee

et al. 2015

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…3 Nesse contexto, a artéria ulnar representa uma alternativa viável capaz de ofertar benefícios semelhantes àqueles advindos da técnica radial, conforme demonstrado em registros prévios. 4,5 Entretanto, publicações pioneiras acerca do tema desencorajam o uso do acesso ulnar após falha na canulação da artéria radial ipsilateral.…”

Section: Safety and Feasibility Of Ulnar Access After Failure Of Ipsiunclassified

“…15 Os autores reportaram taxa de sucesso de 97%, com necessidade de cruzamento para o acesso femoral em 3% dos casos. Apesar da ocorrência de espasmo em 8% dos pacientes e taxa de oclusão assintomática da artéria ulnar de 3%, não houve relato de sinais de Na presente casuística, cujos resultados principais se encontram previamente publicados, 4 demonstramos que, a despeito do espasmo da artéria radial em 80% dos casos de insucesso e do posterior cruzamento para a artéria ulnar ipsilateral, essa via foi utilizada sem im plicações negativas para o paciente, sobretudo quanto ao risco de injúria isquêmica à mão. A possibilidade de efetivar o procedimento mais rapidamente em situações emergenciais, como na intervenção coronária percu tânea primária, na qual a necessidade de preparo do membro superior contralateral ou do membro inferior acarretaria atraso adicional para início do procedi mento, a utilização dos mesmos materiais previamente empregados na tentativa de punção da artéria radial e a maior comodidade para o paciente e o operador jus tificariam a opção pela via ulnar.…”

unclassified

Segurança e Factibilidade do Acesso Ulnar Após Falha do Acesso Radial Ipsilateral

Andrade

Rinaldi

Bienert

et al. 2014

Rev. Bras. Cardiol. Invasiva

Self Cite

View full text Add to dashboard Cite

A escolha da via de acesso para a realização de pro cedimentos coronários invasivos configura uma importante etapa dentro de uma abordagem que contemple a redução de complicações vascula res e de sangramento grave. Embora a técnica femoral se mantenha preponderante, observase um crescimen to consistente na adoção da técnica radial, sabida mente promotora de maior conforto e segurança ao paciente. 1,2 RESUMOIntrodução: Publicações pioneiras desencorajam o uso do aces so ulnar após falha na tentativa de obtenção do acesso radial ipsilateral. Métodos: Registro prospectivo de eficácia e segurança comparando a ocorrência de sangramento e com plicações vasculares entre casos com intenção inicial de utilizar o acesso ulnar e aqueles cujo emprego desse acesso se deu após falha na canulação da artéria radial ipsilateral. Resultados: Entre maio de 2007 e dezembro de 2013, foram rea lizados 11.825 procedimentos coronários invasivos em um único centro, 473 (4%) deles pelo acesso ulnar. Em 65 casos, a canulação da artéria ulnar foi precedida por falha na obten ção do acesso radial ipsilateral. A taxa de sucesso da técnica foi superior a 98%, sendo baixo o número de complicações, em sua maioria decorrentes de hematomas superficiais, sem diferença entre os grupos. Não houve casos de sangramento grave relacionado a via de acesso, pseudoaneurisma, fístula arteriovenosa ou lesão do nervo ulnar adjacente. Conclusões: O acesso ulnar representa uma alternativa segura e eficaz para a realização de procedimentos coronários invasivos selecionados, a despeito de tentativa prévia de obtenção do acesso radial ipsilateral. DESCRITORES: Artéria ulnar. Artéria radial. Angiografia coroná ria. Intervenção coronária percutânea. Hemorragia. ABSTRACT Safety and Feasibility of Ulnar Access After Failure of Ipsilateral Radial AccessBackground: Pioneering publications discourage the use of ulnar access after failed attempt to obtain ipsilateral radial access. Methods: Prospective efficacy and safety registry comparing the incidence of bleeding and vascular complications in patients with an initial intention to use ulnar access and those who used this access after a failed attempt to cannulate the ipsila teral radial artery. Results: Between May 2007 and December 2013, 11,825 invasive coronary procedures were performed at a single center, 473 (4%) of them by ulnar access. In 65 cases, the ulnar artery cannulation was preceded by a failed attempt to obtain the ipsilateral radial access. The technical success rate was higher than 98%, with low complication rates, mostly due to superficial hematomas, and no differences between groups. There were no cases of major bleeding rela ted to the access site, pseudoaneurysm, arteriovenous fistula or injury to the adjacent ulnar nerve. Conclusions: The ulnar access is a safe and effective alternative to perform selected invasive coronary procedures, despite previous attempts to obtain the ipsilateral radial access.

show abstract

Transulnar approach as an alternative access site for coronary invasive procedures after transradial approach failure

Cited by 35 publications

References 17 publications

The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome

The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome

Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta‐analysis of randomized controlled trials

Segurança e Factibilidade do Acesso Ulnar Após Falha do Acesso Radial Ipsilateral

Contact Info

Product

Resources

About