Ulnar Artery Interventions Non-Inferior to Radial Approach: AJmer Ulnar ARtery (AJULAR) Intervention Working Group...

Percutaneous coronary procedures are undergoing a paradigm shift from femoral to forearm approach due to obvious advantages in terms of patient safety and comfort, and faster time to ambulation. Transradial access (TRA) has been established as a primary forearm access site. We have tried to use ulnar artery access as an alternative to radial route and found that transulnar access (TUA) is an excellent alternative and non-inferior to TRA if performed by an experienced operator.

This was a prospective, single-center study involving 2532 patients who were randomized in a 1:1 manner to either TUA (n = 1270) or TRA (n = 1262). All cannulations were performed by operators who were experienced in radial artery (RA) cannulation and had performed a minimum of 50 ulnar artery (UA) cannulations. The primary endpoint was a composite of major adverse cardiac events during hospital stay, crossover to another arterial access route, major vascular events during hospital stay (large hematoma with hemoglobin drop of ≥3 g%) or vessel occlusion rate. To prove non-inferiority of TUA, a margin of 1.93 was derived by fixed-margin method (preserving 50% of difference of procedural failure rate [4.87%] between radial and femoral access from meta-analysis).

The composite primary endpoint occurred in 14.6% of TUA and 14.4% of TRA patients (risk ratio, 1.01; 95% confidence interval, 0.83-1.2; P=.92 at α=0.05). All assessed parameters (except large hematoma, for which non-inferiority could not be proved conclusively) were non-inferior in TUA when compared with TRA.

TUA is non-inferior to TRA when performed by an experienced operator. The utilization of TUA as an access site option increases the chance of success with forearm access and reduces the need for crossover to femoral route.