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Finding the optimal access for proximal upper limb artery (PULA) interventions: Lessons learned from the PULA
Sándor Nardai1, Biljana Zafirovska2, Ákos Pataki1
1Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Percutaneous revascularization of proximal upper limb arteries is safe and effective. Ultrasound-guided distal radial artery puncture offers the safest access, minimizing complications compared to conventional radial access.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Optimal vascular access for proximal upper limb artery (PULA) interventions remains unclear.
- These procedures, involving subclavian, axillary, and innominate arteries, are technically complex.
Purpose of the Study:
- To evaluate optimal puncture sites for PULA interventions.
- To analyze the safety and efficacy of different vascular access methods in PULA interventions.
Main Methods:
- Retrospective analysis of 380 patients treated for symptomatic steno-occlusive PULA disease (Jan 2015-Dec 2019).
- Exclusion of acute thrombotic occlusions.
- Comparison of outcomes between stenotic and occlusive disease groups, and analysis of different access techniques.
Main Results:
- Successful revascularization rates were higher for stenosis (93.75%) than occlusion (86.11%).
- Procedure and fluoroscopy times were longer for occlusions.
- Dual access was more frequent for occlusions without increasing complications.
- Ultrasound-guided distal radial artery puncture showed a significantly lower complication rate (0%) compared to conventional radial access (13.6%).
Conclusions:
- Percutaneous revascularization of PULA is safe and effective.
- Dual access can enhance treatment efficacy without compromising safety.
- Ultrasound-guided distal radial artery puncture is the safest access method for PULA interventions.
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