Advances in trans-ulnar intervention: a successful trans-ulnar artery approach for left subclavian artery stenosis

Techniques for vascular intervention have been evolving in the past decades. Trans-radial artery access (TRA) has been emerging and is favorable over trans-femoral access in recent years due to the lower risk of bleeding complications, vascular injury, early mobilization, shorter hospitalization and lesser cost. TRA has its own limitations such as radial artery stenosis, dissection, spasm and crossover. When access from the conventional sites is complicated or unsuccessful, trans-ulnar artery may serve as a feasible and alternative route. Despite posing potential complications similar to TRA, trans-ulnar artery is a relatively safe approach in an experienced trans-radial operator. We, herein, present a challenging case of subclavian artery revascularization performed via retrograde trans-ulnar approach.