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The Prevalence of Difficult Vascular Anatomy in Transulnar Versus Transradial Access for Cardiac Catheterization in
Mona Maria Grewe1,2, Franziska Fochler2, Peter Hubert Grewe1
1Clinic of Cardiology and Angiology, Klinikum Neumarkt Neumarkt in der Oberpfalz Germany.
Insights
Transulnar artery access (TUA) shows fewer instances of difficult vascular anatomy (DVA) compared to transradial access (TRA) during coronary procedures. TUA may be a better alternative for coronary angiography and intervention when forearm anatomy is challenging.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Transradial access (TRA) is a recommended approach for coronary angiography (CA) and percutaneous coronary intervention (PCI).
- Difficult vascular anatomy (DVA) in forearm arteries poses a significant challenge to the success of TRA.
- Transulnar artery access (TUA) emerges as a potential alternative for navigating these anatomical variations.
Purpose of the Study:
- To compare the prevalence of DVA in forearm arteries between TRA and TUA.
- To evaluate the efficacy of TUA as an alternative to TRA in cases with DVA.
Main Methods:
- Retrospective analysis of 2565 consecutive CA/PCI cases (2403 TRA, 162 TUA) from 2019-2022.
- Classification of DVA into zeroth, first, and second-degree based on guidewire passage success.
- Propensity score matching was used to control for confounding factors between the TRA and TUA groups.
Main Results:
- DVA was significantly more prevalent in the TRA group compared to the TUA group overall (p=0.008).
- Second-degree DVA, where arterial passage was impossible, was more frequent in TRA (2.9%) than TUA (0%) after propensity score matching (p<0.001).
Conclusions:
- Primary TUA demonstrated superiority over TRA in managing DVA of the forearm arteries.
- TUA may offer a more favorable option for CA/PCI, particularly with the increasing use of ultrasound-guided techniques.
Background And Aims:
Transradial access (TRA) is used with a Class IA recommendation for coronary angiography (CA) or percutaneous coronary intervention (PCI). Difficult vascular anatomy (DVA) of the forearm arteries is a challenge to its success. Transulnar artery access (TUA) may constitute a viable alternative.
Methods:
In this single-center study, we retrospectively compared the prevalence of DVA at the forearm arteries in 2565 consecutive cases of CA/PCI (2403 TRA and 162 TUA) between 2019 and 2022. DVA was classified as zeroth-degree if the forearm could be passed with a standard 0.035″ guidewire. First-degree was defined if a standard 0.035″ guidewire had to be switched to a hydrophilic 0.035″ or a 0.018″ guidewire to successfully reach the brachial artery and second-degree DVA if the forearm arteries could not be passed with any guidewire leading to procedural failure.
Results:
In the overall cohort, DVA was significantly more prevalent in TRA versus TUA (zeroth-degree, first-degree, second-degree: 90.3%, 7.2%, and 2.5% vs. 96.9%, 3.1%, and 0%, respectively, p = 0.008). After 4:1 propensity score matching, second-degree DVA remained more prevalent in TRA versus TUA (2.9% (n = 648) vs. 0% (n = 162, p < 0.001)).
Discussion:
In our retrospective analysis, primary TUA was found to be superior to TRA regarding DVA at the forearm arteries. TUA may present a superior alternative to TRA for CA/PCI in the era of ultrasound-guided arterial access.
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