title: Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience.
abstract: OBJECTIVE
  To assess the feasibility and safety of transulnar approach whenever transradial access fails.
  
  
  BACKGROUND
  Radial access for coronary procedures has gained sound recognition. However, the method is not always successful.
  
  
  METHODS
  Between January 2010 and June 2013, diagnostic with or without percutaneous coronary intervention (PCI) was attempted in 2804 patients via the radial approach. Transradial approach was unsuccessful in 173 patients (6.2%) requiring crossover to either femoral (128 patients, 4.6%) or ulnar approach (45 patients, 1.6%). Patients who had undergone ulnar approach constituted our study population. Selective forearm angiography was performed after ulnar sheath placement. We documented procedural characteristics and major adverse cardio-cerebrovascular events.
  
  
  RESULTS
  Radial artery spasm was the most common cause of crossover to the ulnar approach (64.4%) followed by failure to puncture the radial artery (33.4%). Out of 45 patients (82.2%), 37 underwent successful ulnar approach. The eight failed cases (17.8%) were mainly due to absent or weak ulnar pulse (75%). PCI was performed in 17 cases (37.8%), of which 8 patients underwent emergency interventions. Complications included transient numbness, non-significant hematoma, ulnar artery perforation, and minor stroke in 15.5%, 13.3%, 2.2% and 2.2%, respectively. No major cardiac-cerebrovascular events or hand ischemia were noted.
  
  
  CONCLUSIONS
  Ulnar approach for coronary diagnostic or intervention procedures is a feasible alternative whenever radial route fails. It circumvents crossover to the femoral approach. Our study confirms satisfactory success rate of ulnar access in the presence of adequate ulnar pulse intensity and within acceptable rates of complications.
authors: Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat.
authors: Mansour
authors: M
authors: Sallam
authors: Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat.
authors: Adil
authors: A
authors: Al-Riyami
authors: Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat.
authors: Mohammad
authors: M
authors: Misbah
authors: Radiology Department, Sultan Qaboos University Hospital, Muscat.
authors: Rashid
authors: R
authors: Al-Sukaiti
authors: Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat.
authors: Abdallah
authors: A
authors: Al-Alawi
authors: Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat.
authors: Aiman
authors: A
authors: Al-Wahaibi
keywords: Alternative; Coronary procedures; Feasible; Femoral approach; MACCE; Radial; Ulnar