Transulnar approach as an alternative to transradial approach in non-coronary intervention: safety, feasibility and technical factors.

The journal of vascular access

PubMedID: 28430314

Zybulewski A, Edwards M, Kim E, Nowakowski FS, Patel R, Tabori N, Lookstein R, Fischman A. Transulnar approach as an alternative to transradial approach in non-coronary intervention: safety, feasibility and technical factors. J Vasc Access. 2017;0.
PURPOSE
Transulnar access (TUA) has been shown to be an effective alternative to transradial access (TRA) for coronary intervention. This study evaluates the safety and efficacy of TUA in patients undergoing visceral interventions in the setting of contraindication to TRA.

MATERIALS AND METHODS
Patients who underwent visceral interventions via ulnar approach were included in the study. Outcome variables include technical success, access site and bleeding complications.

RESULTS
From May 2014 to September 2016, TUA was attempted 17 times in 14 patients (mean age: 60 years; range: 27 to 81 years) for whom TRA was planned for visceral intervention, but contraindicated. Contraindication to TRA included Barbeau D waveform (n = 3), radial artery diameter <2 mm (n = 8), known radial loop (n = 2), high takeoff of the radial artery (n = 2), prior radial artery occlusion (RAO) (n = 1), and radiocephalic arteriovenous fistula (n = 1). Interventions included selective internal radiation therapy (SIRT) (n = 4), SIRT mapping (n = 2), chemoembolization (n = 6), renal embolization (n = 1) and bland liver embolization (n = 4). Technical success was achieved in 94.1% (16/17 cases) with the single failure attributed to an inability to cannulate the target vessel due to vessel tortuosity, requiring ipsilateral femoral crossover. There were no major access site or bleeding complications. Minor adverse events include two access site hematomas, which were successfully treated with conservative management.

CONCLUSIONS
TUA for visceral interventions is a safe and effective alternative to femoral approach when TRA is contraindicated.