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Coronary angiogram and intervention through transulnar approach.

Pratap C Rath1, Bharat V Purohit, Girish B Navasundi

  • 1Department of Cardiology, Apollo Hospitals, Hyderabad. drpcrath@hotmail.com

Indian Heart Journal
|December 15, 2005
PubMed
Summary

This study evaluated the safety and effectiveness of using the ulnar artery for coronary procedures. A total of 100 patients underwent either diagnostic or interventional procedures through this approach. The majority of patients were male, and the procedures were mostly elective. The success rate was high at 95%, with only a few complications reported. The study suggests that the transulnar approach is a viable and safe alternative to traditional methods like femoral artery access. The findings indicate that this technique could be beneficial for a wide range of patients, especially those at higher risk of bleeding.

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Area of Science:

  • Cardiovascular intervention techniques
  • Minimally invasive coronary procedures
  • Vascular access methods in cardiology

Background:

Prior research has shown that traditional femoral artery access for coronary procedures carries risks like bleeding and vascular complications. No prior work had resolved whether alternative access points could match femoral success rates while reducing complications. This gap motivated exploration of the transulnar approach. It was already known that radial artery access reduces bleeding risks compared to femoral access. That uncertainty drove investigation into whether ulnar artery access could offer further advantages. No prior work had resolved the exact complication rates for ulnar access in coronary procedures. This gap motivated the current study. It was already known that femoral access is associated with higher bleeding risks, especially in elderly patients. That uncertainty drove the need for safer alternatives like transulnar access.

Purpose Of The Study:

The aim of this study was to evaluate the safety and feasibility of using the transulnar artery for coronary procedures. The specific problem addressed was whether this alternative access method could reduce complications while maintaining procedural success. This study sought to compare transulnar access with traditional femoral or radial approaches. The motivation stemmed from the known risks of femoral access and the potential benefits of ulnar access. This study aimed to determine if transulnar access could be a viable alternative for both diagnostic and interventional procedures. The researchers proposed that this method might offer a safer option with fewer access-related complications. The study also aimed to assess the procedural time and success rates associated with this approach. The motivation was to provide clinicians with evidence-based data on the effectiveness of this less commonly used access site.

Keywords:
coronary angiogramvascular accesscardiovascular proceduresulnar artery techniques

Frequently Asked Questions

The procedure was successful in 95 out of 100 patients, with a success rate of 95%.

All interventional patients received aspirin, clopidogrel, and intravenous enoxaparin.

The transulnar approach was used in 99 cases via the right ulnar artery and one case via the left.

Single-vessel angioplasty was performed in 65.7% of interventional cases.

The total procedure time ranged between 25 and 45 minutes.

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Main Methods:

The study involved 100 patients who underwent coronary procedures via the transulnar artery in 2004. The researchers used a single-center observational design to collect data on procedural success and complications. All patients were adults aged 40 to 70 years with a male-to-female ratio of 7.3:1. The transulnar approach was used in 99 cases via the right ulnar artery and one case via the left. The researchers monitored procedural time, success rates, and complications like hematoma or ulnar artery perforation. They recorded the number of patients undergoing single-, double-, and triple-vessel angioplasty. Standard medications including aspirin, clopidogrel, and enoxaparin were administered to all interventional cases. The study design allowed for both elective and emergency procedures to be included in the analysis.

Main Results:

The procedure was successful in 95 out of 100 patients, with 4 unsuccessful diagnostic cases and 1 unsuccessful interventional case. The majority of interventional cases (65.7%) involved single-vessel angioplasty. The total procedure time ranged from 25 to 45 minutes. Only one patient required left ulnar artery access while the rest used the right. Three complications occurred: one local hematoma, one ulnar artery perforation, and one case of reversible paresthesia. All interventional patients received aspirin, clopidogrel, and enoxaparin. Seven patients received glycoprotein IIb/IIIa inhibitors. The success rate of 95% suggests that this approach is highly effective for both diagnostic and interventional procedures.

Conclusions:

The authors propose that the transulnar approach is a safe and feasible alternative for coronary procedures. They suggest that this method may reduce access-related complications compared to femoral or radial approaches. The high success rate of 95% supports its use in both diagnostic and interventional settings. The researchers propose that this approach could be particularly beneficial for patients at higher risk of bleeding. The low complication rate suggests that transulnar access is a viable option for a wide range of patients. The authors suggest that this method could be used in both elective and emergency procedures. The study supports the idea that transulnar access is a practical alternative to more commonly used access sites. The findings suggest that this approach could be integrated into clinical practice with appropriate training.

Three complications occurred: one local hematoma, one ulnar artery perforation, and one case of reversible paresthesia.