title: [Coronary angiography through ipsilateral ulnar approach in a patient with small-diameter radial artery].
abstract: BACKGROUND
  Coronary procedures cannot be completed in 5-15% of cases through initially used radial artery approach due to frequent radial artery anomalies and vasospasm. In these cases, the ulnar artery approach could be the safe and effective alternative wrist approach.
  
  
  METHODS
  A 60-year-old patient with stable angina pectoris, hypertension, dyslipidaemia and positive endurance test was admitted to our hospital for coronary angiography. Due to the backbone pains which also made prolonged lying in bed very uncomfortable and painful, we opted for the wrist approach (standard radial approach) after both modified Allen's tests had been performed, which gave the positive result. After sheath insertion into the right radial artery and unsuccessful advancement of the guidewire and the catheter, we performed the right forearm angiography, which revealed that the right radial artery had a small diameter and the right ulnar artery was the dominant one. Afterwards, the right ulnar artery was cannulated successfully and the coronary angiography was performed through this approach. Both sheaths were removed simultaneously immediately after the procedure and hemostasis was secured by the compression with two Terumo-bands over the puncture sites without any complications. The pulses of both arteries were checked regularly over the next 24 hours and they remained normal. A day after the procedure, the control Doppler-ultrasound check-up was performed and it confirmed the normal flow in both cannulated arteries. One-month follow-up was uneventful, and the patient did not experience any ischemic symptoms of the hand.
  
  
  CONCLUSIONS
  This case is the proof that the ipsilateral ulnar approach can be a safe and effective alternative approach in patients with positive Allen's test after the failure of initial radial attempt in cases where femoral approach should be avoided or the wrist approach should be maintained.
authors.affiliation: Klinika za kardiologiju, Vojnomedicinska akademija, Beograd. zoran0312@yahoo.com
authors.forename: Zoran
authors.initials: Z
authors.lastname: Stajić
authors.forename: Zdravko
authors.initials: Z
authors.lastname: Mijailović
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging; D017535:Ulnar Artery / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler