Transulnar access for coronary angiography and intervention: an early review to guide research and clinical practice

Access for coronary angiography and intervention is increasingly achieved via the radial artery due to the significant risks of femoral access. However, anatomical and size variation mean the radial artery is not always suitable. The ulnar artery is occasionally used as an alternative in such cases, and while ulnar artery puncture may be relatively easy, there are anatomical particulars that could lead to complications following this access route. In the absence of accepted guidelines, this paper examines the available data on ulnar access for coronary procedures. A structured literature search was undertaken to gather peer-reviewed articles and conference abstracts relating to ulnar access. Data from each source were examined in a prescribed way with reference to technical aspects, procedural success or failure, catheter size and complications. A total of 9 publications and 2 conference abstracts were identified, detailing 483 transulnar coronary procedures in 463 cases. There were no randomized, controlled trials. Success occurred in 90.9% of procedures, predominantly using catheter sizes of 4, 5 and 6 Fr, with complications of any type occurring in 4.6% of procedures. Transulnar access may be acceptable in selected cases, but larger data sets are required, preferably of registry or randomized and controlled trial formats.