OBJECTIVES: We evaluated the safety and feasibility of transulnar approach when ipsilateral radial access was not available. METHODS AND RESULTS: From March 2011 until February 2013, 476 consecutive patients who underwent transulnar catheterization were included in a single center prospective registry of effectiveness and safety. Diagnostic coronary angiography accounted for 42% of cases, percutaneous coronary intervention (PCI) for 38%, and 17% underwent carotid artery stenting. A subgroup analysis was done in 240 patients with documented ipsilateral radial artery occlusion (RAO). Procedural success was 97% with a crossover rate of 3% to transfemoral access. Hand ischemia was not observed in any patient on day 1 after procedure and on 1 month follow-up. None of the patients showed ulnar nerve injury. Two patients developed major forearm hematoma that resolved without clinical consequences. Minor access site hematoma occurred in 8%. Severe clinical spasm occurred in two patients. Asymptomatic ulnar artery occlusion at 1 month follow-up was detected in 3.1%. There was no difference between patients with or without RAO in terms of procedural success and any vascular complication. CONCLUSION: Transulnar approach is safe and feasible alternative wrist access when performed by experienced radial operators, providing high success rate and low incidence of vascular complications.
OBJECTIVES: We evaluated the safety and feasibility of transulnar approach when ipsilateral radial access was not available. METHODS AND RESULTS: From March 2011 until February 2013, 476 consecutive patients who underwent transulnar catheterization were included in a single center prospective registry of effectiveness and safety. Diagnostic coronary angiography accounted for 42% of cases, percutaneous coronary intervention (PCI) for 38%, and 17% underwent carotid artery stenting. A subgroup analysis was done in 240 patients with documented ipsilateral radial artery occlusion (RAO). Procedural success was 97% with a crossover rate of 3% to transfemoral access. Hand ischemia was not observed in any patient on day 1 after procedure and on 1 month follow-up. None of the patients showed ulnar nerve injury. Two patients developed major forearm hematoma that resolved without clinical consequences. Minor access site hematoma occurred in 8%. Severe clinical spasm occurred in two patients. Asymptomatic ulnar artery occlusion at 1 month follow-up was detected in 3.1%. There was no difference between patients with or without RAO in terms of procedural success and any vascular complication. CONCLUSION: Transulnar approach is safe and feasible alternative wrist access when performed by experienced radial operators, providing high success rate and low incidence of vascular complications.
Authors: Pietro Di Santo; David T Harnett; Trevor Simard; F Daniel Ramirez; Ali Pourdjabbar; Altayyeb Yousef; Robert Moreland; Jordan Bernick; George Wells; Alexander Dick; Michel Le May; Marino Labinaz; Derek So; Pouya Motazedian; Richard G Jung; Jaya Chandrasekhar; Roxana Mehran; Aun-Yeong Chong; Benjamin Hibbert Journal: CMAJ Date: 2018-04-03 Impact factor: 8.262
Authors: Renato Francesco Maria Scalise; Armando Mariano Salito; Alberto Polimeni; Victoria Garcia-Ruiz; Vittorio Virga; Pierpaolo Frigione; Giuseppe Andò; Carlo Tumscitz; Francesco Costa Journal: J Clin Med Date: 2019-10-18 Impact factor: 4.241