Safety and feasibility of transulnar catheterization when ipsilateral radial access is not available

Abstract

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.

Keywords: carotid artery stenting; percutaneous coronary intervention; radial artery occlusion; transradial approach; transulnar approach.