Transulnar approach as an alternative access site for coronary invasive procedures after transradial approach failure.
BACKGROUND
Unsuccessful radial artery puncture, inability to advance the guide catheter to the ascending aorta, and inadequate guide catheter support represent mechanisms of transradial approach failure. With the rationale of sharing the same efficacy and safety promoted by radial access, the transulnar approach represents an alternative access site for percutaneous coronary procedures.


METHODS
Between May 2007 and May 2012, 11,059 coronary invasive procedures were performed in a single institution: 10,108 by transradial approach (91.4%), 541 by transfemoral approach (4.9%), and 410 by transulnar approach (3.7%). Patients who underwent coronary procedures through transulnar access were included in a prospective registry of effectiveness and safety.


RESULTS
Diagnostic procedures accounted for 71.8% of cases, and the right ulnar access was the most common route (88.9%). Procedure success was high (98.5%), with a crossover rate of 1.5% (6 cases), of which 5 were achieved through the contralateral radial access and 1 through femoral approach. Complications related to access site were low (3.9%), consisting mostly of minor bleeding due to subcutaneous hematomas. There were no cases of major bleeding, nerve injury, pseudoaneurysm, arteriovenous fistula, or necessity of vascular surgical repair.


CONCLUSIONS
The transulnar approach represents an alternative to the transradial approach in selected cases when performed by radial-trained operators, sharing a high success rate and extremely low incidence of access-site complications.
Santa Casa de Marília, Marília, São Paulo, Brazil. pedroberaldo@gmail.com
Pedro Beraldo
PB
de Andrade
Marden André
MA
Tebet
Ederlon Ferreira
EF
Nogueira
Vinícius Cardozo
VC
Esteves
Mônica Vieira Athanazio
MV
de Andrade
André
A
Labrunie
Luiz Alberto
LA
Piva e Mattos
D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery; D017535:Ulnar Artery