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Percutaneous trans-ulnar artery approach for coronary angiography and angioplasty; A case series study
Farshad Roghani-Dehkordi1, Mahmood Hadizadeh2, Fatemeh Hadizadeh3
1Associate Professor, Department of Cardiology and Intervention, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Ulnar artery access for coronary angiography and angioplasty is safe and effective, with a high success rate and minimal complications. This approach offers a viable alternative when radial artery access is not feasible.
Area of Science:
- Cardiology
- Vascular Access
- Interventional Cardiology
Background:
- Coronary angiography is crucial for diagnosing coronary heart disease.
- Femoral access is standard but carries complications.
- Upper extremity approaches, like radial, are gaining favor, but ulnar artery safety remains less understood.
Observation:
- This study monitored 97 patients undergoing coronary angiography or angioplasty via ulnar artery access.
- Follow-up duration ranged from 6 to 10 months.
- Patient demographics included 56% males with a mean age of 57 ± 18 years.
Findings:
- Ulnar access achieved a high procedural success rate of 92.38% in 105 patients.
- Major complications were rare; 89.52% had no complications.
- Minor issues included hematoma (5.1%) and low-grade pain (11%), both manageable.
Implications:
- Ulnar artery access is a safe and practical option for coronary angiography and angioplasty.
- It serves as a valuable alternative when radial artery access is compromised or unavailable.
- This method is particularly useful in patients with prior radial artery harvesting, such as post-coronary artery bypass grafting.
Background:
Coronary angiography is the gold standard method for diagnosis of coronary heart disease and usually performed by femoral approach that has several complications. To reduce these complications, upper extremity approach is increasingly used and is becoming preferred access site by many interventionists. Although radial approach is relatively well studied, safety, feasibility and risk of applying ulnar approach in not clearly known yet.
Methods:
We followed 97 patients (man = 56%, mean ± standard deviation of age = 57 ± 18) who had undergone coronary angiography or angioplasty via ulnar approach for 6-10 months and recorded their outcomes.
Results:
In 97 patients out of 105 ones (92.38%), procedure through ulnar access were successfully done. Unsuccessful puncture (3 patients), wiring (2 patients), passing of sheet (2 patients), and anatomically unsuitable ulnar artery (1 patient) were the reasons of failure. In 94 patients (89.52%), the angiography and angioplasty was done without any complications. Five patients (5.1%) hematoma and 11 patients (11%) experienced low-grade pain that resolved with painkiller. No infection, amputation or need for surgery was reported.
Conclusion:
This study demonstrated that ulnar access in our patients was a safe and practical approach for coronary angiography or angioplasty, without any major complication. Bearing in mind its high success rate, it can be utilized when a radial artery is not useful for the catheterization and in cases such as prior harvesting of the radial artery (in prior coronary artery bypass grafting).
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