The transulnar approach in the patients with ipsilateral radial artery occlusion

Transulnar approach (TUA) has been classified as an appropriate surrogate for the transradial approach (TRA), but the safety of TUA in the presence of ipsilateral radial artery occlusion (RAO) is not well studied. In this article, we aimed to assess the feasibility and occurrence of complications of this approach in Iranian individuals with ipsilateral RAO.

In this prospective double-center study, a total number of 70 participants from July 2017 to November 2018 with coexisting ipsilateral RAO due to prior RA angiography, severe arterial spasm, prominent vascular anomalies, or arterial harvesting for hemodialysis or graft procedures were enrolled and underwent TUA. Incidence of probable complications including pain, hematoma, arteriovenous fistula (AVF), pseudoaneurysm formation, any adverse events requiring immediate vascular surgery, life-threatening hand ischemia, infection, ulnar nerve palsy, major adverse cardiac events (MACE) including death, myocardial infarction (MI), or stroke plus ulnar artery (UA) obstruction and narrowing was evaluated both before discharge time and one month afterward.

The mean age of the study population was 68.2 ± 12.8 years [men number: 41 (58.5%)]. Our success rate was 98.6% and 37.1% of subjects underwent further coronary intervention. No aforementioned adverse outcomes were reported in any individual except for pain (11.4%) and minor hematoma (grade I) (5.7%) as well as MACE (1.4%). Follow-up assessment revealed asymptomatic UA occlusion (UAO) and severe narrowing in 2.8% and 1.4% of participants, respectively.

Our outcomes suggested that due to high safety and low complication rates, TUA could be tried safely in patients with concurrent ipsilateral RAO. Other appropriate cohort studies are required for assessing the incidence of TUA complications.