Transulnar access for coronary angiography and percutaneous coronary intervention

The use of transradial access for cardiac catheterization and percutaneous coronary intervention (PCI) has increased substantially in recent years. However, the transradial approach may not be feasible in certain patients. Although the transulnar approach can serve as an alternative approach in these subjects, it is infrequently used. We performed a detailed search of the current literature and identified 21 studies, including randomized controlled trials, case series, and abstract presentations at major conferences. The data reviewed are structured in an organized fashion to provide information on both feasibility and safety of this approach. Transulnar cardiac catheterization was reported in >2400 patients with a success rate exceeding 90% in most studies. The limited in-hospital and short-term clinical outcomes data demonstrate satisfactory safety of this approach in small-to-medium sized investigated cohorts. However, long-term safety and efficacy of this approach need to be further substantiated in large PCI cohorts before endorsing transulnar access as an alternative to transfemoral and transradial approaches in the majority of patients.