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Updated: Jul 29, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Well-palpable pulse over an occluded radial artery: A case series reporting ultrasound outcomes
Paweł Lewandowski1, Anna Zuk1, Andrzej Budaj1
1Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland.
Insights
Radial artery occlusion can complicate vascular access for coronary angiography. Ultrasound can detect this occlusion, and the transulnar approach may be a safe alternative for patients needing procedures like percutaneous coronary intervention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Radial artery occlusion is a known complication of cardiac catheterization.
- Repeated procedures can increase the risk and challenge vascular access.
- Identifying alternative access routes is crucial for patient management.
Purpose of the Study:
- To highlight challenges in vascular access for patients with prior coronary angiography.
- To emphasize the utility of preprocedural ultrasound in detecting radial artery occlusion.
- To explore the transulnar approach as a safe alternative for coronary angiography.
Main Methods:
- Case series of four patients with radial artery occlusion.
- Preprocedural ultrasound examination of forearm arteries.
- Assessment of collateral circulation, including the anterior interosseous artery.
- Performance of transulnar approach for coronary angiography.
Main Results:
- Four patients presented with radial artery occlusion after previous procedures.
- Ultrasound effectively detected radial artery occlusion and assessed collateral flow.
- The anterior interosseous artery was identified as a potential collateral supply.
- The transulnar approach was successfully used for coronary angiography in these patients.
Conclusions:
- Preprocedural ultrasound is beneficial for evaluating vascular access in patients with radial artery occlusion.
- The transulnar approach can be a safe and effective alternative for coronary angiography when radial access is compromised.
- Collateral circulation assessment is key to selecting alternative vascular access routes.
Abstract:
We report a case series of four patients with radial artery occlusion complicating vascular access who were scheduled for coronary angiography. We describe the challenges in selecting adequate vascular access in patients with a history of coronary angiography and percutaneous coronary intervention, as well as the benefits of using preprocedural ultrasound examination of forearm arteries to detect radial artery occlusion. Our case series suggests that if the anterior interosseous artery provides partial blood supply to the hand as a collateral circulation of the occluded radial artery, the transulnar approach may be an alternative safe option for coronary angiography and percutaneous coronary intervention in this population.
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