title: Transulnar catheterization in patients with ipsilateral radial artery occlusion.
abstract: BACKGROUND
  The transradial approach to percutaneous coronary intervention (PCI) has recently gained popularity among interventionalists. However, radial artery occlusion (RAO) limits the ability for repeat catheterization. In current practice, transulnar catheterization is thought to be a contraindication in patients with ipsilateral RAO.
  
  
  METHODS
  Seventeen consecutive patients undergoing transulnar catheterization and PCI were reviewed. Each of the patients had clinical follow-up post-procedure at days 1, 7, and 30.
  
  
  RESULTS
  We successfully performed 17 ulnar catheterizations in patients with ipsilateral RAO. All patents were subsequently found to have adequate collaterals from the anterior interosseous branch. One patient developed ulnar artery spasm and another patient developed a forearm hematoma. Overall, no patient suffered any ulnar nerve injury. The ulnar artery was patent both by palpation and by the presence of an adequate plethysmographic signal during follow-up at days 1, 7, and 30. No patients developed with any signs or symptoms of hand ischemia during follow-up.
  
  
  CONCLUSIONS
  In patients with RAO, ipsilateral transulnar catheterization may not be an absolute contraindication. Our results suggest that extensive collaterals from the anterior interosseous artery may be the reason for protection against hand ischemia in the setting of RAO.
authors.affiliation: Beth Israel Medical Center, New York, New York; SUNY Downstate Medical Center at Long Island College Hospital, Brooklyn.
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ratcliffe
authors.forename: Muhammad
authors.initials: M
authors.lastname: Chaudhry
authors.forename: Yili
authors.initials: Y
authors.lastname: Huang
authors.forename: Sally
authors.initials: S
authors.lastname: Wong
authors.forename: Xuanjing
authors.initials: X
authors.lastname: Zhou
authors.forename: Samir
authors.initials: S
authors.lastname: Pancholy
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D012039:Regional Blood Flow; D013997:Time Factors; D017535:Ulnar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D014654:Vascular Patency