J Transcat Intervent.2019;27:eA20190005.

Contemporary analysis of the ulnar technique as an alternative arterial access in invasive coronary procedures

Pedro Beraldo de Andrade, Fábio Salerno Rinaldi, Igor Ribeiro de Castro Bienert, Robson Alves Barbosa, Marden André Tebet, Vinícius Cardozo Esteves, Sérgio Kreimer, Felipe Souza Maia da Silva, Cleverson Neves Zukowski, Ederlon Ferreira Nogueira, André Labrunie, Luiz Alberto Piva e Mattos

DOI: 10.31160/JOTCI201927A20190005

ABSTRACT

Background

When it is not suitable to use the radial access in invasive coronary procedures, the ulnar technique is a feasible and safe alternative. The objective of the present study was to characterize the relevance of the ulnar technique in the daily practice of a center that adopts the radial strategy as the first option.

Methods

The sample was extracted from a single-center prospective registry, from May 2008 to October 2018, including all patients undergoing invasive coronary procedures in a large tertiary care hospital. The efficacy of the technique was determined by the need for crossover to another access route to finish the procedure. Vascular complications, such as hematoma, pseudoaneurysm, arterial occlusion, ischemic injury of the hand, compartment syndrome, arteriovenous fistula, infection, and the need for repairing vascular surgery, were evaluated at the time of hospital discharge, defining the safety outcomes.

Results

In the analyzed period, 608 patients underwent ulnar access procedures. The mean age was 62.4 years, with a predominance of female patients (52.6%) and a high prevalence of cardiovascular risk factors. The procedures were mostly diagnostic (71.4%) and were performed by right ulnar access (86.7%). The efficacy of the technique was high (98.2%), and complications associated with the access route were infrequent, with a rate of 1.6% for asymptomatic ulnar artery occlusion, and of 3.1% for hematoma.

Conclusion

The ulnar technique as an alternative access route is not very often used, but it is useful when the radial access is inadequate or in cases of failed radial artery cannulation.

Contemporary analysis of the ulnar technique as an alternative arterial access in invasive coronary procedures

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