Transradial Angiography and interventionTransulnar approach as an alternative access site for coronary invasive procedures after transradial approach failure
Section snippets
Methods
Patients who underwent coronary procedures through transulnar access were included in a prospective registry of effectiveness and safety. The effectiveness of the technique was evaluated by procedure success rate, defined as completion of coronary angiography and left ventriculography with adequate coronary opacification, and percutaneous coronary intervention obtaining residual lesion less than 20%, with no need of crossover. The procedure and fluoroscopy times were obtained starting from the
Results
Between May 2007 and May 2012, 11,059 coronary invasive procedures were performed in a single institution: 10,108 by transradial approach (91.4%), 541 by transfemoral approach (4.9%), and 410 by transulnar approach (3.7%), the last representing the analyzed sample. 387 patients were included, of whom 210 (54.3%) were women, the mean age was 61.2 ± 11.4 years, and 139 (35.9%) were diabetic. The baseline clinical characteristics of patients are shown in Table I.
Stable angina or silent ischemia
Discussion
In the present registry, we report the results of 410 coronary procedures performed using the transulnar approach. During 5 years, 387 patients, representing approximately 4% of the cases, were selected for the transulnar approach, when the radial approach proved to be unavailable or prone to technical failure, especially for a small caliber or weak pulse on physical examination, justifying the high percentage of women in our sample. We achieved a high success rate of the technique in our
Conclusions
Our registry adds data to the available evidence regarding the feasibility, efficacy, and safety of the transulnar approach for invasive coronary procedures. Since bleeding complications are associated with increased morbidity and mortality, the transulnar approach represents an elegant alternative to the transradial approach in selected cases when performed by radial-trained operators, sharing a high success rate and extremely low incidence of access site complications.
References (25)
- et al.
Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention: a report from the National Cardiovascular Data CathPCI Registry
J Am Coll Cardiol
(2012) - et al.
Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial
Lancet
(2011) - et al.
Mechanism and predictors of failed transradial approach for percutaneous coronary interventions
J Am Coll Cardiol Interv
(2009) - et al.
Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures
Am Heart J
(2012) - et al.
Effectiveness of ulnar artery catheterization after failed attempt to cannulate a radial artery
Am J Cardiol
(2005) - et al.
Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty
Cathet Cardiovasc Diagn
(1997) - et al.
Percutaneous ulnar artery approach for coronary angiography: a preliminary report in nine patients
Cathet Cardiovasc Interv
(2001) - et al.
Ulnar artery cannulation for coronary angiography and percutaneous coronary intervention: case reports and anatomic considerations
Cathet Cardiovasc Interv
(2002) - et al.
Percutaneous ulnar artery approach for primary coronary angioplasty: safety and feasibility
Cathet Cardiovasc Interv
(2004) - et al.
Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium
Circulation
(2011)
A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation
Circulation
Transulnar versus transradial artery approach for coronary angioplasty: the PCVI-CUBA Study
Cathet Cardiovasc Interv
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2017, Cardiovascular Revascularization MedicineCitation Excerpt :The ability to use large size (7F) guiding catheters, for example by using short sheaths, low-profile sheaths (such as Slender, Terumo, Warren, New Jersey) [16] or by using sheathless guide catheters, such as the Eaucath (Asahi, Nagoya, Japan) [17], combined with the development of strategies to increase guide support in radial access, such as use of guide catheter extensions [18] and the side branch anchor technique [19], has allowed for successful utilization of a radial approach for complex coronary lesions, including CTOs [20–22]. These developments have also sparked interest in selective utilization of ulnar access, with experienced centers reporting good outcomes with this approach [23,24]. This increase in forearm approach utilization may facilitate the uptake of SDD strategy after PCI, although currently available data suggest that access route may in fact not affect the outcome of SDD [10,25,26].
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A Technical Guide Describing the Use of Transradial Access Technique for Endovascular Interventions
2015, Techniques in Vascular and Interventional RadiologyCitation Excerpt :Many operators have used the ulnar artery as an alternative to the radial artery, especially if radial artery spasm or severe tortuosity is encountered or if the ulnar artery is dominant. De Andrade et al29 described their experience with transulnar access in a prospective registry of 410 patients, with a low access site complication rate of 3.9%. Other potential applications for TRA in the future include renal artery denervation and carotid, iliac, and infrainguinal interventions.
Transradial primary percutaneous coronary intervention
2015, Interventional Cardiology ClinicsCitation Excerpt :Transulnar artery cannulation (TUA) has been proposed as an alternative access for interventions in patients with small-caliber radial artery or thin radial pulse and stronger pulsation of the ulnar artery. Larger studies have further confirmed the safety and effectiveness of TUA as an alternative wrist approach to TRA for coronary interventions.16,54 The procedural success, advantages, and complication rates for transulnar interventions seem to be similar to those of TRA.15,54
Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience
2014, Journal of the Saudi Heart Association