Transulnar artery approach for percutaneous coronary intervention: an alternative route in a patient with challenging transfemoral access and hypoplastic radial artery.

Transradial coronary angiography and intervention has become a popular technique due to reduced local and bleeding complications, easier post-procedural care and patient preference. In certain patients, transradial access may not be possible due to various anatomical reasons. Usually, the transfemoral route is used for these patients. In a minority of patients, such as those with significant peripheral arterial disease or obesity, the transfemoral approach is challenging and is associated with an increased risk of local complications or bleeding. Transulnar arterial access, however, has recently been shown to be feasible and safe for both coronary angiography and intervention. The procedural success, advantages and complication rates for this procedure appear similar to those for the transradial approach. We describe a case of transulnar artery percutaneous coronary intervention in an obese patient with a hypoplastic radial artery.