Same wrist intervention via the cubital (ulnar) artery in case of radial puncture failure for percutaneous cardiac catheterization or intervention: the multicenter SWITCH registry.
OBJECTIVE
The radial approach is safer than the femoral for percutaneous coronary procedures. However its feasibility is lower, mainly for technical issues, often related to failure to puncture or cannulate the radial artery. The ulnar approach is a valid alternative to radial. We aimed to test the incidence, feasibility and safety of a direct homolateral ulnar approach in case of failed radial sheath insertion.


RESULTS
Five operators collected their 1-year activity (diagnostic and interventional) with focus on entry site. Entry site choice was left to operators' discretion. In case of failed radial sheath insertion, an attempt to cannulate the homolateral ulnar artery was mandated, if ulnar pulse was present. All patients in whom this attempt was performed were followed until discharge. Out of 2403 procedures (1271 interventions), the final successful entry site was radial in 66.5%, femoral in 31.0%, ulnar in 2.1% and brachial in 0.4%. Radial failure occurred in 117 patients (6.9%). In 75 patients, the radial failure was not due to sheath insertion (which was successful), but to lack of catheter support or to tortuosity of the subclavian/brachial arteries. In the remaining 42 (35.9% of all radial failures), a homolateral ulnar approach was attempted. A successful cannulation of the ulnar artery occurred in 36 patients (85.7%) with further performance of the complete procedure. Concerning local complications, 1 radial pseudo-aneurysm (treated with additional compression) occurred, while no cases of early hand ischemia were reported.


CONCLUSIONS
In this multicenter registry, in case of failed radial sheath insertion, switching directly to the homolateral ulnar artery for percutaneous coronary procedures is feasible and it appears to be safe, without cases of symptomatic hand ischemia.
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: agostonipf@gmail.com.
Pierfrancesco
P
Agostoni
Andrea
A
Zuffi
Benjamin
B
Faurie
Paolo
P
Tosi
Mariam
M
Samim
Anouar
A
Belkacemi
Michiel
M
Voskuil
Pieter R
PR
Stella
Enrico
E
Romagnoli
Giuseppe
G
Biondi-Zoccai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011677:Punctures / Q000009:adverse effects* / Q000379:methods; D017534:Radial Artery / Q000000981:diagnostic imaging*; D011859:Radiography; D012042:Registries; D017211:Treatment Failure; D017535:Ulnar Artery / Q000000981:diagnostic imaging*; D014953:Wrist / Q000098:blood supply*; D055815:Young Adult
Catheterization; Percutaneous coronary intervention; Radial artery catheter; Ulnar artery