Safety and efficacy of transulnar approach for coronary angiography and intervention.
BACKGROUND
Transradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach. The objective of this study was to evaluate the safety and efficacy of the transulnar approach versus the transradial approach for coronary angiography and intervention.


METHODS
Two hundred and forty patients undergoing coronary angiography, followed or not by intervention, were randomized to transulnar (TUA) or transradial approach (TRA). Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalization and 30 days follow-up. Major adverse cardiac events (MACE) as secondary end point was recorded till 30 days follow-up.


RESULTS
Successful puncture was achieved in 98.3% (118/120) of patients in the TUA group, and in 100% (120/120) of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 days after procedures was 11.0% vs.12.3% and 5.1% vs. 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs.1.7% of patients 1 day and 30 days after transulnar angioplasty, and in 6.6% vs. 4.9% of patients 1 day and 30 days after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively (P = 0.949). No big forearm hematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 days follow-up was observed in all patients.


CONCLUSIONS
The transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or thin radial pulse.
Li
Yun-Zhi
YZ
Department of Cardiology, Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China.
Zhou
Yu-Jie
YJ
Zhao
Ying-Xin
YX
Guo
Yong-He
YH
Liu
Yu-Yang
YY
Shi
Dong-Mei
DM
Wang
Zhi-Jian
ZJ
Jia
De-An
DA
Yang
Shi-Wei
SW
Nie
Bin
B
Han
Hong-Ya
HY
Hu
Bin
B
D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000000981:diagnostic imaging*; D014463:Ultrasonography