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Faisaluddin M, Sattar Y, Song D, Titus A, Erdem S, Alsaud A, Alharbi AA, Sulaiman S, Khan SU, Elgendy IY, Sengodan P, Dani SS, Alam M, Alraies MC, Daggubati R. Cardiovascular Outcomes of Transulnar Versus Transradial Percutaneous Coronary Angiography and Intervention: A Regression Matched Meta-Analysis. Am J Cardiol 2023; 201:92-100. [PMID: 37352671 DOI: 10.1016/j.amjcard.2023.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/25/2023]
Abstract
Transradial access (TRA) and transulnar access (TUA) are in close vicinity, but TRA is the preferred intervention route. The cardiovascular outcomes and access site complications of TUA and TRA are understudied. Databases, including MEDLINE and Cochrane Central registry, were queried to find studies comparing safety outcomes of both procedures. The outcome of interest was in-hospital mortality and access site bleeding. Secondary outcomes were all-cause major adverse cardiovascular events, crossover rate, artery spasm, access site large hematoma, and access site complications between TUA and TRA. A random-effect model was used with regression to report unadjusted odds ratios (ORs) by limiting confounders and effect modifiers, using software STATA V.17. A total of 4,796 patients in 8 studies were included in our analysis (TUA = 2,420 [50.4%] and TRA = 2,376 [49.6%]). The average age was 61.3 and 60.1 years and the patients predominantly male (69.2% vs 68.4%) for TUA and TRA, respectively. TUA had lower rates of local access site bleeding (OR 0.58, 95% confidence interval 0.34 to 0.97, I2 = 1.89%, p = 0.04) but higher crossover rate (OR 1.80, 95% confidence interval 1.04 to 3.11, I2 = 75.37%, p = 0.04) than did TRA. There was no difference in in-hospital mortality, all-cause major adverse cardiovascular events, arterial spasm, and large hematoma between both cohorts. Furthermore, there was no difference in procedural time, fluoroscopy time, and contrast volume used between TUA and TRA. TUA is a safer approach, associated with lower access site bleeding but higher crossover rates, than TRA. Further prospective studies are needed to evaluate the safety and long-term outcomes of both procedures.
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Affiliation(s)
| | - Yasar Sattar
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - David Song
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center, New York, New York
| | - Anoop Titus
- Saint Vincent Hospital, Worcester, Massachusetts
| | - Saliha Erdem
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Ali Alsaud
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Anas A Alharbi
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Samian Sulaiman
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Safi U Khan
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, Texas
| | - Islam Y Elgendy
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Prasanna Sengodan
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Sourbha S Dani
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Mahboob Alam
- Department of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, DMC Heart Hospital, Detroit, Michigan
| | - Ramesh Daggubati
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia.
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Manzoor MU, Almulhim IA, Alrashed AA, Alturki AY, Alghabban FA, Al-Qahtani SM. Common ground, different path: Ulnar artery access for interventional neurovascular procedures. Interv Neuroradiol 2021; 28:463-468. [PMID: 34515561 PMCID: PMC9326858 DOI: 10.1177/15910199211040280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recently, radial artery access has gained popularity for interventional neurovascular procedures due to patient comfort and fewer complications. However, there are instances where the radial artery approach is not feasible. In such cases, trans-ulnar artery access (TUA) can offer an alternate route. There is limited data regarding neuro-interventional procedures performed via this approach. This study aims to evaluate the feasibility and safety of trans-ulnar approach for a wide range of interventional neurovascular procedures. MATERIALS AND METHODS The data for all patients who underwent ulnar artery access for diagnostic or interventional neuroradiology procedures was retrospectively collected between September 2020 and March 2021. Patient demographics, procedural details, procedure success, and complications were recorded. RESULTS During the study period, 23 patients underwent 24 trans-ulnar approach procedures. The mean age of patients was 50.1 ± 14.2 years. Fourteen diagnostic cerebral angiograms and ten interventional procedures were performed. All procedures were successfully completed via trans-ulnar approach without a switch to alternate access. No major access site complication was observed. CONCLUSION Ulnar artery access is a safe and feasible option for neurovascular procedures. It can be effectively utilized for diagnostic cerebral angiography and a wide range of interventional procedures.
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Affiliation(s)
- Muhammad U Manzoor
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim A Almulhim
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah A Alrashed
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Y Alturki
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia.,Department of Neurosurgery, National Neuroscience Institute, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fatimah A Alghabban
- Department of Neurosurgery, 48172King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia
| | - Sultan M Al-Qahtani
- Department of Medical Imaging, Diagnostic & Interventional Neuroradiology section, 37849King Fahad Medical City, Riyadh, Saudi Arabia
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Sedhom R, Megaly M, Abraham B, George JC, Kalra S, Janzer S. Transulnar Versus Transradial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 26:39-45. [DOI: 10.1016/j.carrev.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
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The Impact of Using a Larger Forearm Artery for Percutaneous Coronary Interventions on Hand Strength: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10051099. [PMID: 33800778 PMCID: PMC7961765 DOI: 10.3390/jcm10051099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 01/14/2023] Open
Abstract
(1) Background: The exact mechanism underlying hand strength reduction (HSR) after coronary angiography with transradial access (TRA) or transulnar access (TUA) remains unknown. (2) Methods: This study aimed to assess the impact of using a larger or smaller forearm artery access on the incidence of HSR at 30-day follow-up. This was a prospective randomized trial including patients referred for elective coronary angiography or percutaneous coronary intervention. Based on the pre-procedural ultrasound examination, the larger artery was identified. Patients were randomized to larger radial artery (RA) or ulnar artery (UA) or a group with smaller RA/UA. The primary endpoint was the incidence of HSR, while the secondary endpoint was the incidence of subjective HSR, paresthesia, and any hand pain. (3) Results: We enrolled 200 patients (107 men and 93 women; mean age 68 ± 8 years) between 2017 and 2018. Due to crossover between TRA and TUA, there were 57% (n = 115) patients in larger RA/UA and 43% (n = 85) patients in smaller RA/UA. HSR occurred in 29% (n = 33) patients in larger RA/UA and 47% (n = 40) patients in smaller RA/UA (p = 0.008). Subjective HSR was observed in 10% (n = 12) patients in larger RA/UA and 21% (n = 18) patients in smaller RA/UA (p = 0.03). Finally, paresthesia was noted in 7% (n = 8) patients in larger RA/UA and 22% (n = 15) in smaller RA/UA (p = 002). Independent factors of HSR were larger RA/UA (OR 0.45; 95% CI, 0.24-0.82; p < 0.01) and the use of TRA (OR 1.87; 95% CI, 1.01-34; p < 0.05). (4) Conclusions: The use of a larger artery as vascular access was associated with a lower incidence of HSR at 30-day follow-up.
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Kar S, Shah A. Outcomes of Dorsal Distal Radial, Radial, and Ulnar Artery Percutaneous Coronary Intervention With Ultrasound Guidance in Acute Myocardial Infarction. Curr Probl Cardiol 2021; 46:100822. [PMID: 33752064 DOI: 10.1016/j.cpcardiol.2021.100822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Ultrasound utilization during access enables precise vessel cannulation. We sought to evaluate the outcomes of ultrasound guided dorsal distal radial artery (DDRA), radial, and ulnar cardiac catheterization (CC) and percutaneous coronary intervention (PCI). We performed a prospective observational study of 224 patients (58 ± 12 years) at an academic medical center from October 2016 to March 2020 (median follow-up of 13 months) and compared the outcomes of ultrasound guided DDRA, ulnar, or radial artery CC and PCI. Groups were divided into DDRA (n = 18, 8.0%), ulnar (n = 94, 42.0%) and radial access (n = 112, 50.0%). Primary endpoints included the number of access attempts and conversion to femoral access. Secondary endpoints included all-cause mortality, cardiac mortality, acute myocardial infarction (AMI), stroke, repeat revascularization, stent thrombosis, in-stent restenosis, and access site complications. In the primary endpoints, no significant difference was found amongst groups in the number of access attempts (P = 0.272) or conversion to femoral access (P = 0.381). In the radial group (59 ± 11 years, median follow-up of 16 months), 2 cardiac mortalities (1 lymphocytic myocarditis, 1 AMI) and 2 noncardiac mortalities occurred. None of the secondary endpoints occurred in the DDRA (66 ± 17 years, median follow-up of 13 months) or ulnar group (56 ± 11 years, median follow-up of 14 months). DDRA and ulnar PCI was safe and efficacious with no complications. Femoral conversion or the number of access attempts was not different between DDRA, ulnar, or radial. Therefore, DDRA and ulnar are viable alternatives for PCI, which can preserve radial for future use.
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Affiliation(s)
- Subrata Kar
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX
| | - Aayush Shah
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX.
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TransRadial versus transUlnar artery approach for elective invasive percutaneous coronary interventions: a randomized trial on the feasibility and safety with ultrasonographic outcome - RAUL study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 16:376-383. [PMID: 33598009 PMCID: PMC7863831 DOI: 10.5114/aic.2020.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/22/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Transradial access (TRA) for coronary angiography (CAG) and percutaneous coronary intervention (PCI) is superior to transfemoral access (TFA). Transulnar access (TUA) is an alternative to TRA. Aim To compare the efficacy and safety of TRA vs. TUA in patients scheduled for CAG or PCI. Material and methods This was a prospective, single-center, randomized study conducted between 2013 and 2016. Two hundred patients referred for the first elective CAG were included in the study. Eligible patients were then randomly assigned to the TRA or TUA group. Before and after the invasive procedure, all patients underwent ultrasonographic measurements of the right upper limb arteries. Results The primary endpoint was efficacy, defined as a successful CAG without a crossover of vascular access. The secondary endpoint was safety, assessed as the number of vascular complications. Successful coronary angiography via the access site was 95% vs. 75% in the TRA vs. TUA groups, respectively (p < 0.001). It depended on the anatomy of UA and the operator experience. No differences were observed in early and late follow-up complications. Conclusions TRA was superior to TUA with regard to efficacy. TUA occurred a safe approach for CAG and PCI and could be used as an alternative method of forearm access.
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Smits MWL, van der Schaaf RJ, Herrman JP, Kuipers RS. Transulnar coronary intervention complicated by compartment syndrome. BMJ Case Rep 2021; 14:e237339. [PMID: 33563688 PMCID: PMC7875296 DOI: 10.1136/bcr-2020-237339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a compartment syndrome after transulnar coronary intervention. As far as we are aware of, this is the first report of such a complication after a transulnar approach described in the literature. Compartment syndrome is a very rare but possibly devastating complication of coronary angiography and percutaneous coronary interventions. We retrospectively observed an incidence rate of 0.007% after 13,948 coronary angiographies or 0.013% after 7532 interventions performed through the wrist in our centre in the last 5 years. Rapid recognition and treatment of this rare complication may prevent long-term morbidity and are thus of utmost importance. General measures should be taken to reduce this incidence of this serious complication.
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Affiliation(s)
| | | | | | - Remko S Kuipers
- Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Impact of the Use of a Larger Forearm Artery on the Efficacy and Safety of Transradial and Transulnar Access: A Randomized Trial with Preprocedural Ultrasonography. J Clin Med 2020; 9:jcm9113607. [PMID: 33182392 PMCID: PMC7697068 DOI: 10.3390/jcm9113607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/04/2023] Open
Abstract
(1) Background: We aimed to assess the impact of the selection of a larger radial or ulnar artery on the efficacy of access and vascular complications, based on preprocedural ultrasonographic examination. (2) Methods: This prospective, randomized trial included patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Patients were randomized into either a larger ulnar artery (UA) or radial artery (RA) group or smaller UA/RA group. The primary endpoint was successful CAG/PCI without crossover to another artery. The secondary endpoints were incidences of radial or ulnar artery occlusion (RAO/UAO) at the 24 h and 30 day follow-up. (3) Results: Between 2017 and 2018, 200 patients (107 men, mean age 68 ± 8 years) were enrolled. The success of CAG/PCI via the access site was 98% and 83% (p < 0.001) in the larger UA/RA group and smaller UA/RA group, respectively. The independent factor for CAG/PCI success was the larger artery (OR 9.8, 95%CI 2.11–45.5; p < 0.005). The larger UA/RA was superior, with RAO/UAO at 24 h: OR 0.07, 95%CI 0.09–0.61; p < 0.016; and RAO/UAO at 30 days: OR 0.25, 95%CI 0.05–0.12; p < 0.001. (4) Conclusions: Larger artery access was shown to be more efficient and safer than recessive forearm artery access.
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Shafiq M, Mahmoud HB, Fanous ML. Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center. Egypt Heart J 2020; 72:60. [PMID: 32915325 PMCID: PMC7486347 DOI: 10.1186/s43044-020-00089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Trans-ulnar approach was proposed primarily for elective procedures in patients not suitable for trans-radial approach that was introduced two decades ago. The trans-ulnar approach is as safe and effective as the trans-radial approach for coronary angiography and intervention. Aim This study’s aim was to assess the feasibility and safety of the trans-ulnar approach in coronary procedures as a preliminary experience for operators experienced in trans-radial approach with no/minimal trans-ulnar approach experience at an Egyptian center. Results Vascular access in 120 patients was selected randomly for coronary angiography and angioplasty—80 through radial and 40 through ulnar approach. Patients were examined for local complications and Doppler evaluation to both radial and ulnar arteries a day after the procedure was done. Ulnar approach success was 82.5% versus 93.7% in the radial group; failure of ulnar artery puncture was the only cause of crossover in the ulnar group, while occurrence of persistent spasm was the leading cause of crossover in the radial group followed by radial artery tortuosity. The procedure time of coronary angiography and percutaneous coronary intervention of the ulnar group was significantly higher than that of the radial group (P value = 0.011 and 0.034, respectively). The mean caliber of the right ulnar artery was 2.45 ± 0.38, slightly larger than that of the radial artery 2.33 ± 0.38 at the level of the wrist, but this difference was statistically non-significant. Conclusion Our study demonstrated that ulnar access with experienced radial operators and in our patients is a safe and practical approach for coronary angiography or angioplasty, without any major complications. Bearing in mind its high success rate, it can be used when a radial artery is not useful for the catheterization or as a default approach on the expense of slightly longer procedural time.
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Affiliation(s)
- Mohammad Shafiq
- Cardiology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt.
| | | | - Malak Lamie Fanous
- Cardiology Department, Sohag Heart and GIT Specialized Center, Sohag, Egypt
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Gokhroo RK, Chandra K, Nandal R, Bisht DS, Gupta S, Kishor K, Avinash A, Pandey S, Roy R, Phogat A, Tasleem TM, Kaul A. The initial experience of 2495 cases of the ulnar artery as default access for coronary diagnostic and interventional procedures at a single center: An observational study. Indian Heart J 2020; 72:184-188. [PMID: 32768018 PMCID: PMC7411112 DOI: 10.1016/j.ihj.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction Upper limb arterial access is being increasingly used for coronary diagnostic and intervention procedures. Radial artery access is associated with reduced morbidity and mortality as compared to femoral artery access. However, access to the radial artery is not always successful with reported crossover rates to other routes between 3% and 8%. Ulnar artery access is emerging an attractive option both as upfront access and rescue access in case of failure to obtain radial artery access. Aims - To assess and document the feasibility and safety of ulnar access as a default strategy. Methods 2654 patients planned for coronary diagnostic and intervention procedureswere assessed for inclusion. Inclusion criteria were, all patients planned for coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpable ulnar pulse. Exclusion criteria included reverse Barbeau test type D, previous procedure resulting in radial artery occlusion/excision, hemodialysis patients having ipsilateral AV fistula and severe forearm deformities. Results 2525 patients were found eligible, out of which 2495 (98.81%) were successfully cannulated. Procedure was completed in 2414 patients. Local site bleeding in 40 (1.6%) and acute loss of ulnar pulse noted in 33 (1.3%) out of 2495 patients. None of the patients had gangrene of access site, pseudo-aneurysm, arteriovenous fistula or neurological deficit post procedure. Conclusion The Ulnar artery access as a default access is safe and feasible option for patient undergoing coronary diagnostic and interventional procedures.
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Affiliation(s)
- Rajendra K Gokhroo
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India.
| | - Kailash Chandra
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Rajesh Nandal
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Devendra S Bisht
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Sajal Gupta
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Kamal Kishor
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - A Avinash
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Shashikant Pandey
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Ramsagar Roy
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Ashish Phogat
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Tarik Mohammad Tasleem
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
| | - Anushri Kaul
- Post Graduate Department of Cardiology, Jawahar Lal Nehru Medical College & Associated Group of Hospitals, Ajmer, India
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Gunduz Y, Gunduz H, Ayhan LT, Ciner M, Cakmak A, Saribiyik B, Akcay C, Ilguz E, Cosansu K. The Ulnar Artery as a Favorable Primary or Alternative Access Site for Coronary Angiography and Interventions. Angiology 2020; 71:417-424. [PMID: 32166958 DOI: 10.1177/0003319720907031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The transulnar approach (TUA) has been considered both as primary access and as a secondary access site after transradial access (TRA) failure for coronary invasive procedures. However, there is little evidence supporting the use of the TUA as the first approach to diagnostic coronary angiography (CAG) or interventions. Patients (n = 587) who underwent CAG and/or angioplasty (292 patients via TRA, 295 patients via TUA) were included. The primary end points of the study were major adverse cardiac events and major vascular events (hematoma, vascular occlusion, vasospasm), and secondary end points included angiographic success, crossover rate, and angiographic procedural times. The mean age was 60 ± 21 years. The composite primary end points occurred in 34 (11.6%) patients in the TRA and 22 (7.4%) patients in the TUA arm (P < .001). More arterial occlusion and more arterial spasm than in the TUA and similar urgent target vessel revascularization were observed in the TRA group in 48 hours. Based on previous studies and our clinical experience, we speculated that the TUA performed by an experienced operator has equal status with the TRA for coronary catheterization, especially in patients with a palpable ulnar pulse.
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Affiliation(s)
- Yasemin Gunduz
- Medical Faculty, Radiology Department, Sakarya University, Sakarya, Turkey
| | - Huseyin Gunduz
- Medical Faculty, Cardiology Department, Sakarya University, Sakarya, Turkey
| | - Lacin Tatli Ayhan
- Medical Faculty, Radiology Department, Sakarya University, Sakarya, Turkey
| | - Mahmut Ciner
- Medical Faculty, Radiology Department, Sakarya University, Sakarya, Turkey
| | - Ahmetcan Cakmak
- Medical Faculty, Cardiology Department, Sakarya University, Sakarya, Turkey
| | - Betul Saribiyik
- Medical Faculty, Cardiology Department, Sakarya University, Sakarya, Turkey
| | - Cagla Akcay
- Medical Faculty, Cardiology Department, Sakarya University, Sakarya, Turkey
| | - Ersin Ilguz
- Medical Faculty, Cardiology Department, Sakarya University, Sakarya, Turkey
| | - Kahraman Cosansu
- Medical Faculty, Cardiology Department, Sakarya University, Sakarya, Turkey
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Goldsweig AM, Secemsky EA. Vascular Access and Closure for Peripheral Arterial Intervention. Interv Cardiol Clin 2020; 9:117-124. [PMID: 32147114 DOI: 10.1016/j.iccl.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripheral arterial interventions require safe and effective vascular access and closure. The sites, techniques, and equipment used may vary depending on patient and procedural factors. To minimize the risk of procedural complications, arterial access should use micropuncture technique, ultrasound and fluoroscopic guidance, a compressible arterial access site, and the smallest diameter sheath necessary. Hemostasis at an arteriotomy site may be achieved by manual compression, device-mediated compression, an intravascular closure device, or an extravascular closure device. Although closure devices improve patient comfort and expedite hemostasis, they have not been shown to reduce complications in comparison with compression.
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Affiliation(s)
- Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Eric A Secemsky
- Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, USA
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Kuo F, Park J, Chow K, Chen A, Walsworth MK. Avoiding peripheral nerve injury in arterial interventions. ACTA ACUST UNITED AC 2020; 25:380-391. [PMID: 31310240 DOI: 10.5152/dir.2019.18296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arterial access sites to avoid injury.
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Affiliation(s)
- Frank Kuo
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Park
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kira Chow
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Alice Chen
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew K Walsworth
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Distal Radial and Ulnar Arteries: the Alternative Forearm Access. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22:1. [DOI: 10.1007/s11936-020-0801-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mahmoud K, Elamragy A, ElNaggar W, Abou-Elezz M. Safety of duplex ultrasound-assisted transulnar versus transradial arterial access for invasive coronary procedures: A search for safe alternative access. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2020. [DOI: 10.4103/ijca.ijca_33_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Shroff AR, Gulati R, Drachman DE, Feldman DN, Gilchrist IC, Kaul P, Lata K, Pancholy SB, Panetta CJ, Seto AH, Speiser B, Steinberg DH, Vidovich MI, Woody WW, Rao SV. SCAI expert consensus statement update on best practices for transradial angiography and intervention. Catheter Cardiovasc Interv 2019; 95:245-252. [DOI: 10.1002/ccd.28672] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Adhir R. Shroff
- Division of CardiologyDepartment of Medicine, University of Illinois at Chicago Chicago, IL
| | - Rajiv Gulati
- Cardiovascular DiseasesMayo Clinic Rochester Minnesota
| | | | - Dmitriy N. Feldman
- Weill Cornell Medical CollegeNew York Presbyterian Hospital New York New York
| | - Ian C. Gilchrist
- Milton S. Hershey Medical CenterPenn State University Hershey Pennsylvania
| | | | - Kusum Lata
- CardiologySutter Health Tracy, Sacramento California
| | - Samir B. Pancholy
- CardiologyNorth Penn Cardiovascular Specialists Clarks Summit Pennsylvania
| | | | - Arnold H. Seto
- CardiologyUniversity Of California Irvine Orange California
| | | | | | - Mladen I. Vidovich
- Division of CardiologyDepartment of Medicine, University of Illinois at Chicago Chicago, IL
| | - Walter W. Woody
- CardiologyBaptist Memorial Hospital‐North MS Oxford Mississippi
| | - Sunil V. Rao
- Department of MedicineDuke Clinical Research Institute Durham North Carolina
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17
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Abstract
Over the past 2 decades, radial artery access has increasingly become the standard approach for coronary angiography and intervention. Compared with femoral arteries, transradial access is associated with better hemostasis. Transradial access has increased patient preference, facilitates early ambulation, and is cost-effective. An important limitation of transradial access is access site failure, and it carries a crossover rate of 3% to 7% in randomized prospective trials comparing radial with femoral artery access among experienced operators. Crossover rates for failed primary radial artery access can be reduced with ultrasonography guidance and increased familiarity with alternative access sites in the wrist.
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Affiliation(s)
- Sridevi R Pitta
- Cox Health System, University of Missouri School of Medicine, 3800 S National Avenue, Suite # 700, Springfield, MO 65807, USA.
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
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18
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Ranwa BL, Priti K. Transulnar versus Transradial Access as a Default Strategy for Percutaneous Coronary Intervention. Heart Views 2019; 20:152-157. [PMID: 31803371 PMCID: PMC6881864 DOI: 10.4103/heartviews.heartviews_96_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/21/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Percutaneous coronary interventions (PCI) are undergoing a paradigm shift from femoral to forearm approach due to obvious advantages in terms of patient safety, comfort, and faster ambulation. Transradial access (TRA) has been established as a primary forearm access site. Use of transulnar access (TUA) as an alternative to radial route can serve as novel forearm access to the interventionalists. Aim: The aim of this study is to evaluate TUA versus TRA access as a default strategy for PCI. Materials and Methods: This was a prospective, single-center randomized controlled trial involving 2700 patients, of whom 220 underwent PCI in 1:1 randomization to TUA (n = 110) or TRA (n = 110). The primary endpoint was composite of major adverse cardiac events during hospital stay, cross-over to another arterial site, major vascular events of the arm during hospital stay (large hematoma with hemoglobin drop of ≥5 g%) and occlusion rate. Secondary endpoints were individual components of primary endpoint and spasm of the vessel. Results: Two groups did not differ in baseline characteristics. On intention to treat (ITT) analysis, primary end point occurred in 10.91% of TUA and 12.73% of TRA arm (odds ratio [OR]: 0.84; 95% confidence interval [CI], 0.37–1.91; P = 0.68 at α = 0.05). Further on per protocol (PP) analysis, primary end point occurred in 9.21% of TUA and 11.11% of TRA arm (OR: 0.81; 95% CI, 0.29–2.30; P = 0.68 at α = 0.05). Secondary endpoints also did not differ significantly between the two groups in ITT and PP analysis. Conclusions TUA is an excellent alternative to TRA, while performing PCI when performed by an experienced operator. When utilized as an option, TUA increases the chance of success with forearm access and reduces the need for cross over to femoral route.
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Affiliation(s)
- Bhanwar L Ranwa
- Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India
| | - Kumari Priti
- Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India
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19
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Pawel L, Dagmara GL, Pawel M, Bogumil R, Andrzej B, Sebastian S. Efficacy and safety of kaolin-based hemostatic pad vs. standard mechanical compression following transradial and transulnar access for elective coronary angiography and PCI: RAUL trial substudy. Heart Vessels 2019; 35:502-508. [PMID: 31655876 PMCID: PMC7085472 DOI: 10.1007/s00380-019-01520-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/02/2019] [Indexed: 01/09/2023]
Abstract
Hemostatic devices used in the transradial approach (TRA) and transulnar approach (TUA) are limited. This study compared the efficacy and safety of hemostasis using the QuikClot Radial hemostatic pad (QC) vs. standard mechanical compression (SC) after coronary angiography (CAG). This prospective single-center randomized trial included CAG patients. The primary and secondary endpoints were efficacy (successful hemostasis) and safety (total artery occlusion [TAO], pseudoaneurysm, hematoma), respectively. A visual analog scale (VAS) evaluated patient pain during compression. In 2013–2017, 200 patients were randomized 2 × 2 into the: (1) TRA and TUA groups and (2) QC and SC groups. Successful hemostasis was achieved in 92 (92%) patients in the QC group and 100 (100%) patients in the SC group (p < 0.006). The TRA SC subgroup showed significantly better results than the TRA QC subgroup (100% vs. 90.0%; p < 0.03). Similar results were obtained in the TUA QC and TUA SC subgroups (95% vs. 100%; p = 0.5). The secondary endpoint was achieved in the QC and SC groups (8% vs. 9%; p = 0.8). Patients reported significantly less pain during QC application than during SC (VAS: 2.6 ± 2.6 vs. 3.4 ± 2.9; p < 0.03). In patients undergoing CAG with TRA or TUA, QC was associated with lower efficacy, less discomfort, and similar safety compared to SC.
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Affiliation(s)
- Lewandowski Pawel
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland.
| | - Gralak-Lachowska Dagmara
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Maciejewski Pawel
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Ramotowski Bogumil
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Budaj Andrzej
- Centre of Postgraduate Medical Education, Grochowski Hospital, Cardiology Department, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Stec Sebastian
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
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20
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Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches. J Clin Med 2019; 8:jcm8101727. [PMID: 31635342 PMCID: PMC6833028 DOI: 10.3390/jcm8101727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022] Open
Abstract
Since its introduction, the transradial access for percutaneous cardiovascular procedures has been associated with several advantages as compared to transfemoral approach, and has become the default for coronary angiography and intervention. In the last 30 years, a robust amount of evidence on the transradial approach has been mounted, promoting its diffusion worldwide. This article provides a comprehensive review of radial artery access for percutaneous cardiovascular interventions, including the evidence from clinical trials of transradial vs. transfemoral approach, technical considerations, access-site complications and limitations, alternative forearm accesses (e.g., ulnar and distal radial artery), and ultimately the use of the radial approach for structural interventions.
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21
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Kar S. Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization. Catheter Cardiovasc Interv 2019; 94:706-713. [DOI: 10.1002/ccd.28398] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/18/2019] [Accepted: 07/04/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Subrata Kar
- Division of Cardiovascular MedicineTexas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine El Paso Texas
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22
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Hahalis GN, Leopoulou M, Tsigkas G, Xanthopoulou I, Patsilinakos S, Patsourakos NG, Ziakas A, Kafkas N, Koutouzis M, Tsiafoutis I, Athanasiadis I, Koniari I, Almpanis G, Anastasopoulou M, Despotopoulos S, Kounis N, Dapergola A, Aznaouridis K, Davlouros P. Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography. JACC Cardiovasc Interv 2018; 11:2241-2250. [DOI: 10.1016/j.jcin.2018.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
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23
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Vidovich MI. Ulnar Artery Catheterization: Is This Our Second Access Site or Is It Still Femoral? Curr Cardiol Rep 2018; 20:91. [DOI: 10.1007/s11886-018-1039-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Hahalis G, Tsigkas G, Kounis N, Patsilinakos S, Kafkas N, Ziakas A, Patsourakos N, Almpanis G, Koniari I, Xanthopoulou I, Koutsogiannis N, Despotopoulos S, Leopoulou M, Tassi V, Miliordos I, Anastasopoulou M, Roumeliotis A, Dapergola A, Aznaouridis K, Chatzis D, Davlouros P. Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates. Angiology 2018; 69:755-762. [DOI: 10.1177/0003319718754466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As “it may all be appropriate anticoagulation” for a simplified approach against RAO, the results of an ongoing trial comparing 100 with 50 IU/kg body weight in transradial CAG are eagerly awaited.
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Affiliation(s)
- George Hahalis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Nikos Kounis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | - Antonios Ziakas
- Department of Cardiology, “AHEPA” University Hospital, Thessaloniki, Greece
| | | | - George Almpanis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | | | - Marianna Leopoulou
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Vasiliky Tassi
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Ioannis Miliordos
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | - Athina Dapergola
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Konstantinos Aznaouridis
- Department of Cardiology, “Hippokration” University Hospital, Athens, Greece
- Department of Cardiology, “Castle Hill” Hospital, Cottingham, UK
| | | | - Periklis Davlouros
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
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25
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Fernandez R, Zaky F, Ekmejian A, Curtis E, Lee A. Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: Systematic review and meta-analysis. Catheter Cardiovasc Interv 2018; 91:1273-1280. [PMID: 29388387 DOI: 10.1002/ccd.27479] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/29/2017] [Accepted: 12/08/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Trans-radial access has rapidly become the standard for percutaneous coronary procedures in the last decade. As proceduralists overcome the learning curve and become more competent in trans-radial access, alternative safe access sites such as the ulnar artery have been increasingly used for emergent and elective procedures. The aim of this study was to synthesize the best available evidence of the impact on major adverse cardiac events (MACE) of ulnar artery compared to radial artery cardiac catheterization. METHODS This review considered randomized controlled trials that included adult patients who had a percutaneous coronary procedure via the radial or ulnar artery. The intervention of interest was the use of ulnar compared to radial artery for cardiac catheterization. An extensive search was undertaken for published and unpublished trials up to May 2017. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Data were analyzed using Review Manager. RESULTS A total of six trials were included in the review. There was no statistically significant difference in the incidence of MACE between patients who underwent trans-ulnar or trans-radial artery catheterization (OR 0.90; 95% CI 0.65-1.25). Complications associated with access including hematoma formation, (n = 6 trials) pseudo-aneurysm, and arterio-venous fistulae formation (n = 5 trials), were investigated in a total of 5,276 patients, with no difference in these complications noted between the two groups. There were no differences in arterial access time, fluoroscopy time, and contrast load between the two groups. CONCLUSIONS There is evidence to support safe use of the ulnar artery as an alternative to the radial artery for access for cardiac catheterization.
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Affiliation(s)
- Ritin Fernandez
- The University of Wollongong, Wollongong, New South Wales, Australia.,St George Hospital, Kogarah, New South Wales, Australia
| | - Fady Zaky
- The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Avedis Ekmejian
- The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Elizabeth Curtis
- The University of Wollongong, Wollongong, New South Wales, Australia.,Western Sydney University, Sydney, New South Wales, Australia
| | - Astin Lee
- The Wollongong Hospital, Wollongong, New South Wales, Australia
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26
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Roberts JS, Niu J. A novel technique for simultaneous hemostasis of ipsilateral radial and ulnar artery access sites. Catheter Cardiovasc Interv 2017; 91:901-904. [DOI: 10.1002/ccd.27351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Jonathan S. Roberts
- Memorial Cardiac and Vascular Institute, Memorial Regional Hospital, Memorial Healthcare SystemHollywood Florida
| | - Jianli Niu
- Memorial Cardiac and Vascular Institute, Memorial Regional Hospital, Memorial Healthcare SystemHollywood Florida
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27
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Hahalis G, Aznaouridis K, Tsigkas G, Davlouros P, Xanthopoulou I, Koutsogiannis N, Koniari I, Leopoulou M, Costerousse O, Tousoulis D, Bertrand OF. Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTEry Occlusion Meta-Analys IS) Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.005430. [PMID: 28838915 PMCID: PMC5586412 DOI: 10.1161/jaha.116.005430] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Incidence of radial artery occclusions (RAO) and ulnar artery occclusions (UAO) in coronary procedures, factors predisposing to forearm arteries occlusion, and the benefit of anticoaggulation vary significantly in existing literature. We sought to determine the incidence of RAO/UAO and the impact of anticoagulation intensity. Methods and Results Meta‐analysis of 112 studies assessing RAO and/or UAO (N=46 631) were included. Overall, there was no difference between crude RAO and UAO rates (5.2%; 95% confidence interval [CI], 4.4–6.0 versus 4.0%; 95% CI, 2.8–5.8; P=0.171). The early occlusion rate (in‐hospital or within 7 days after procedure) was higher than the late occlusion rate. The detection rate of occlusion was higher with vascular ultrasonography compared with clinical evaluation only. Low‐dose heparin was associated with a significantly higher RAO rate compared with high‐dose heparin (7.2%; 95% CI, 5.5–9.4 versus 4.3%; 95% CI, 3.5–5.3; Q=8.81; P=0.003). Early occlusions in low‐dose heparin cohorts mounted at 8.0% (95% CI, 6.1–10.6). The RAO rate was higher after diagnostic angiographies compared with coronary interventions, presumably attributed to the higher intensity of anticoagulation in the latter group. Hemostatic techniques (patent versus nonpatent hemostasis), geography (US versus non‐US cohorts) and sheath size did not impact on vessel patency. Conclusions RAO and UAO occur with similar frequency and in the order of 7% to 8% when evaluated early by vascular ultrasonography following coronary procedures. More‐intensive anticoagulation is protective. Late recanalization occurs in a substantial minority of patients.
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Affiliation(s)
| | - Konstantinos Aznaouridis
- Hippokration Hospital, Athens Medical School, Athens, Greece.,Castle Hill Hospital, Cottingham, United Kingdom
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28
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Transulnar cardiac catheterization and percutaneous coronary intervention: techniques, transradial comparisons, anatomical considerations, and comprehensive literature review. Catheter Cardiovasc Interv 2017; 90:1126-1134. [DOI: 10.1002/ccd.27220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/15/2017] [Accepted: 07/02/2017] [Indexed: 11/07/2022]
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Transulnar approach as an alternative to transradial approach in non-coronary intervention: safety, feasibility and technical factors. J Vasc Access 2017; 18:250-254. [DOI: 10.5301/jva.5000691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/20/2022] Open
Abstract
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.
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30
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Bi X, Wang Q, Liu D, Gan Q, Liu L. Is the Complication Rate of Ulnar and Radial Approaches for Coronary Artery Intervention the Same? Angiology 2017; 68:919-925. [PMID: 28387125 DOI: 10.1177/0003319717703226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared the clinical outcomes of patients who underwent coronary artery intervention by the transulnar and transradial artery approaches. In this 1 year, single-center study, patients were randomized to either a radial artery (RA) or ulnar artery (UA) group. Of 538 patients, the primary outcome, arterial occlusion of a forearm artery, occurred in 21 of 225 patients in the RA group compared to 6 of 220 patients in the UA group (9.3% vs 2.7%, P = .007). The rate of arterial occlusion was significantly lower following ulnar access compared to radial (odds ratio [OR] = 3.85, P = .006). A higher risk of occlusion was associated with repeated procedures rather than a single procedure (OR = 5.14, P = .003), smoking (OR = 2.39, P = .04), and arterial to sheath diameter ratio of ≤1 (OR = 2.62, P = .03). However, the disadvantage of UA was an increase of incidence of hematomas (13.2% vs 5.8%, P = .01) and symptoms of discomfort (15.5% vs 5.8%, P = .002). In conclusion, the transulnar strategy proved to be noninferior to the transradial approach for coronary procedures ( ClinicalTrials.gov Identifier: NCT01979627).
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Affiliation(s)
- Xile Bi
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Qingsheng Wang
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Defeng Liu
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Quan Gan
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Li Liu
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
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31
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Sattur S, Singh M, Kaluski E. Trans-ulnar catheterization and coronary interventions: From technique to outcomes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:299-303. [PMID: 28216229 DOI: 10.1016/j.carrev.2017.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
The ulnar artery is similar in size to the radial artery, however it is more difficult to palpate and access. For those physicians who mastered trans-ulnar access (TUA) this access site serves as an alternative to trans radial access (TRA) when the radial artery access is rendered suboptimal (by palpation, ultrasound examination or previous procedural records) or when encountering TRA difficulties or failure. The manuscript describes the anatomy, suggested technique, procedural success and complications associated with TUA. Data from single center registries and randomized studies show that TUA has a lower and more variable success rate than TRA, however these 2 approaches carry similar safety profile and complications rates. The authors suggest that interventionalists should consider, learn and master TUA to maintain higher success rate of wrist based interventions while avoiding the potential complications, discomfort and costs of trans-femoral approach.
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Affiliation(s)
- Sudhakar Sattur
- Division of Cardiology Robert Packer Hospital, Guthrie Health Systems, Sayre, PA; The Commonwealth Medical College, Scranton, PA
| | - Maninder Singh
- Division of Cardiology Robert Packer Hospital, Guthrie Health Systems, Sayre, PA; The Commonwealth Medical College, Scranton, PA
| | - Edo Kaluski
- Division of Cardiology Robert Packer Hospital, Guthrie Health Systems, Sayre, PA; The Commonwealth Medical College, Scranton, PA.
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32
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Current practice of transradial approach for coronary procedures: A survey by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Radial Club. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:154-159. [PMID: 28119043 DOI: 10.1016/j.carrev.2017.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/06/2017] [Accepted: 01/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transradial approach (TRA) for percutaneous coronary procedures is associated with improved patient outcome and is being increasingly adopted worldwide. We surveyed Italian interventional cardiologists in order to take a snapshot of the current practice of TRA. METHODS A web-based questionnaire was emailed to all members of the Italian Society of Interventional Cardiology. RESULTS The survey was taken by 508 respondents. Cardiogenic shock and chronic total occlusions represented the principal limitations to TRA. Right TRA was the default approach for 81% of respondents. Both diagnostic and interventional procedures were routinely performed through 6 Fr sheaths (83% and 93%, respectively); dedicated TRA curves were used in 11% of diagnostic and in about 3% of interventional procedures. Almost 70% of the operators did not assess dual hand circulation. In case of crossover, the contralateral radial artery was the preferred site (57%). Radial artery hemostasis was mostly achieved by pneumatic bracelet (64%) and patency of the radial artery during hemostasis was ensured in 60% of cases. Pre-discharge patency of the radial artery was routinely assessed by almost 60% of respondents. For diagnostic procedures, adequate heparin anticoagulation (5000IU) was only given by 45% of operators. Most respondents believed that TRA is associated with greater radiation exposure for both the patient (82%) and the operator (98%) as compared to transfemoral approach. CONCLUSIONS This survey provides contemporary data about the adoption of TRA in Italy and gives interesting insights about several technical and clinical issues related to the practice of this vascular approach for coronary procedures.
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Hsueh SK, Cheng CI, Fang HY, Omran MM, Liu WH, Chung WJ, Chen CJ, Yang CH, Fang CY, Wu CJ. Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion. Int Heart J 2017; 58:313-319. [DOI: 10.1536/ihj.16-244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | | | - Wen-Hao Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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Ford TJ, Ng MK, Thondapu V, Barlis P. Radial Artery, Alternative Arm Access, and Related Techniques. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Thomas J. Ford
- St. George Hospital; Sydney Australia
- University of New South Wales; Sydney Australia
| | - Martin K.C. Ng
- University of New South Wales Medical School, The University of Sydney; Australia
- Royal Prince Alfred Hospital; Sydney Australia
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Hahalis G, Deftereos S, Bertrand OF. Ulnar artery: The Ulysses ultimate resort for coronary procedures. Hellenic J Cardiol 2016; 57:S1109-9666(16)30146-4. [PMID: 27712911 DOI: 10.1016/j.hjc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.
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Plourde G, Pancholy SB, Nolan J, Jolly S, Rao SV, Amhed I, Bangalore S, Patel T, Dahm JB, Bertrand OF. Radiation exposure in relation to the arterial access site used for diagnostic coronary angiography and percutaneous coronary intervention: a systematic review and meta-analysis. Lancet 2015; 386:2192-203. [PMID: 26411986 DOI: 10.1016/s0140-6736(15)00305-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transradial access for cardiac catheterisation results in lower bleeding and vascular complications than the traditional transfemoral access route. However, the increased radiation exposure potentially associated with transradial access is a possible drawback of this method. Whether transradial access is associated with a clinically significant increase in radiation exposure that outweighs its benefits is unclear. Our aim was therefore to compare radiation exposure between transradial access and transfemoral access for diagnostic coronary angiograms and percutaneous coronary interventions (PCI). METHODS We did a systematic review and meta-analysis of the scientific literature by searching the PubMed, Embase, and Cochrane Library databases with relevant terms, and cross-referencing relevant articles for randomised controlled trials (RCTs) that compared radiation parameters in relation to access site, published from Jan 1, 1989, to June 3, 2014. Three investigators independently sorted the potentially relevant studies, and two others extracted data. We focused on the primary radiation outcomes of fluoroscopy time and kerma-area product, and used meta-regression to assess the changes over time. Secondary outcomes were operator radiation exposure and procedural time. We used both fixed-effects and random-effects models with inverse variance weighting for the main analyses, and we did confirmatory analyses for observational studies. FINDINGS Of 1252 records identified, we obtained data from 24 published RCTs for 19 328 patients. Our primary analyses showed that transradial access was associated with a small but significant increase in fluoroscopy time for diagnostic coronary angiograms (weighted mean difference [WMD], fixed effect: 1·04 min, 95% CI 0·84-1·24; p<0·0001) and PCI (1·15 min, 95% CI 0·96-1·33; p<0·0001), compared with transfemoral access. Transradial access was also associated with higher kerma-area product for diagnostic coronary angiograms (WMD, fixed effect: 1·72 Gy·cm(2), 95% CI -0·10 to 3·55; p=0·06), and significantly higher kerma-area product for PCI (0·55 Gy·cm(2), 95% CI 0·08-1·02; p=0·02). Mean operator radiation doses for PCI with basic protection were 107 μSv (SD 110) with transradial access and 74 μSv (68) with transfemoral access; with supplementary protection, the doses decreased to 21 μSv (17) with transradial access and 46 μSv (9) with transfemoral. Meta-regression analysis showed that the overall difference in fluoroscopy time between the two procedures has decreased significantly by 75% over the past 20 years from 2 min in 1996 to about 30 s in 2014 (p<0·0001). In observational studies, differences and effect sizes remained consistent with RCTs. INTERPRETATION Transradial access was associated with a small but significant increase in radiation exposure in both diagnostic and interventional procedures compared with transfemoral access. Since differences in radiation exposure narrow over time, the clinical significance of this small increase is uncertain and is unlikely to outweigh the clinical benefits of transradial access. FUNDING None.
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Affiliation(s)
| | - Samir B Pancholy
- The Wright Center for Graduate Medical Education, The Commonwealth Medical Center, Scranton, PA, USA
| | - Jim Nolan
- University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Sanjit Jolly
- McMaster University and the Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sunil V Rao
- The Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Imdad Amhed
- The Wright Center for Graduate Medical Education, The Commonwealth Medical Center, Scranton, PA, USA
| | | | - Tejas Patel
- Apex Heart Institute; Department of Cardiology, Sheth VS General Hospital, Ahmedabad, India; Smt NHL Municipal Medical College, Ahmedabad, India
| | - Johannes B Dahm
- Department of Cardiology-Angiology, Heart & Vascular Center Neu-Bethlehem, Göttingen, Germany
| | - Olivier F Bertrand
- Quebec Heart-Lung Institute, Laval University, QC, Canada; Department of Mechanical Engineering, McGill University, Montreal, QC, Canada.
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Interosseous artery collaterals and their support to ulno-palmar arch: A case report and a review of the literature. Int J Cardiol 2015; 197:280-1. [PMID: 26142975 DOI: 10.1016/j.ijcard.2015.06.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/20/2015] [Indexed: 02/08/2023]
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Dahal K, Rijal J, Lee J, Korr KS, Azrin M. Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv 2015; 87:857-65. [DOI: 10.1002/ccd.26221] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/09/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Khagendra Dahal
- Department of Medicine; LRGHealthcare; Laconia New Hampshire
| | - Jharendra Rijal
- Department of Medicine; Miriam Hospital, Alpert Medical School of Brown University; Providence Rhode Island
| | - Juyong Lee
- Division of Cardiology; Calhoun Cardiology Center, University of Connecticut Health Center; Farmington Connecticut
| | - Kenneth S. Korr
- Division of Cardiology; Miriam Hospital, Alpert Medical School of Brown University Providence; Rhode Island
| | - Michael Azrin
- Division of Cardiology; Calhoun Cardiology Center, University of Connecticut Health Center; Farmington Connecticut
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The choice of arterial access for percutaneous coronary intervention and its impact on outcome: An expert opinion perspective. Am Heart J 2015; 170:13-22. [PMID: 26093860 DOI: 10.1016/j.ahj.2015.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/23/2015] [Indexed: 11/20/2022]
Abstract
The prevention of major bleeding during percutaneous coronary intervention is one of the most widely discussed and often controversial topics within interventional cardiology. The choice of arterial access should be considered a mechanism for bleeding avoidance, and various strategies have been proposed to prevent or lower major bleeding and vascular complications with varying levels of strength. Herein, we review the current literature on arterial access as a bleeding avoidance strategy during percutaneous coronary intervention and its impact on outcome and provide a consensus opinion based on the strength of the evidence supporting various techniques.
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Hahalis G, Tsigkas G, Kakkos S, Panagopoulos A, Tsota I, Davlouros P, Xanthopoulou I, Koniari I, Grapsas N, Christodoulou I, Almpanis G, Leopoulou M, Kounis N, Alexopoulos D. Vascular Complications Following Transradial and Transulnar Coronary Angiography in 1600 Consecutive Patients. Angiology 2015; 67:438-43. [PMID: 26124493 DOI: 10.1177/0003319715592095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major, noncoronary complications are rarely encountered following transradial coronary procedures. METHODS AND RESULTS Among 1600 prospectively studied patients with complete follow-up, 7 patients experienced major complications following coronary forearm procedures corresponding to an incidence of 0.44%. We found inadvertent symptomatic intramyocardial contrast medium injection, 2 cases with compartment syndrome of which 1 was managed surgically, exertional hand ischemia due to radial artery occlusion, a large ulnar artery pseudoaneurysm, an ulnar arteriovenous fistula, and 1 critical hand ischemia due to late occlusion of the distal brachial artery. CONCLUSIONS Although infrequent, surveillance for major complications should be encouraged after forearm coronary procedures.
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Affiliation(s)
- George Hahalis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Stavros Kakkos
- Department of Vascular Surgery, Patras University Hospital, Rio, Patras, Greece
| | | | - Irene Tsota
- Department of Radiology, Patras University Hospital, Rio, Patras, Greece
| | - Periklis Davlouros
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | - Ioanna Koniari
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Nikos Grapsas
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | - George Almpanis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Marianna Leopoulou
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Nicholas Kounis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
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Majithia A, Levy MS. Transulnar angiography and intervention: The next frontier in vascular access? Catheter Cardiovasc Interv 2015; 86:49-50. [DOI: 10.1002/ccd.26058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/19/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Arjun Majithia
- Section of Interventional Cardiology; Lahey Hospital and Medical Center; Burlington Massachusetts
| | - Michael S. Levy
- Section of Interventional Cardiology; Lahey Hospital and Medical Center; Burlington Massachusetts
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Hahalis G, Xathopoulou I, Tsigkas G, Almpanis G, Christodoulou I, Grapsas N, Davlouros P, Koniari I, Deftereos S, Raisakis K, Christopoulou G, Giannopoulos G, Kounis N, Pyrgakis V, Alexopoulos D. A comparison of low versus standard heparin dose for prevention of forearm artery occlusion after 5 French coronary angiography. Int J Cardiol 2015; 187:404-10. [DOI: 10.1016/j.ijcard.2015.03.366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 01/28/2023]
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Rao SV, Kedev S. Approaching the post-femoral era for coronary angiography and intervention. JACC Cardiovasc Interv 2015; 8:524-6. [PMID: 25819182 DOI: 10.1016/j.jcin.2014.12.231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina.
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University of St. Cyril & Methodius, Skopje, Macedonia
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Gokhroo R, Bisht D, Padmanabhan D, Gupta S, Kishor K, Ranwa B. Feasibility of ulnar artery for cardiac catheterization: AJmer ULnar ARtery (AJULAR) catheterization study. Catheter Cardiovasc Interv 2015; 86:42-8. [DOI: 10.1002/ccd.25806] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/25/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Rajendra Gokhroo
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Devendra Bisht
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Deepak Padmanabhan
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Sajal Gupta
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Kamal Kishor
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
| | - Bhanwar Ranwa
- Post Graduate Department of Cardiology; JLN Medical College & Associated Group of Hospitals; Ajmer Rajasthan 305 001 India
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Sallam M, Al-Riyami A, Misbah M, Al-Sukaiti R, Al-Alawi A, Al-Wahaibi A. Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience. J Saudi Heart Assoc 2014; 26:138-44. [PMID: 24954986 DOI: 10.1016/j.jsha.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 12/27/2013] [Accepted: 01/03/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess the feasibility and safety of transulnar approach whenever transradial access fails. BACKGROUND Radial access for coronary procedures has gained sound recognition. However, the method is not always successful. METHODS Between January 2010 and June 2013, diagnostic with or without percutaneous coronary intervention (PCI) was attempted in 2804 patients via the radial approach. Transradial approach was unsuccessful in 173 patients (6.2%) requiring crossover to either femoral (128 patients, 4.6%) or ulnar approach (45 patients, 1.6%). Patients who had undergone ulnar approach constituted our study population. Selective forearm angiography was performed after ulnar sheath placement. We documented procedural characteristics and major adverse cardio-cerebrovascular events. RESULTS Radial artery spasm was the most common cause of crossover to the ulnar approach (64.4%) followed by failure to puncture the radial artery (33.4%). Out of 45 patients (82.2%), 37 underwent successful ulnar approach. The eight failed cases (17.8%) were mainly due to absent or weak ulnar pulse (75%). PCI was performed in 17 cases (37.8%), of which 8 patients underwent emergency interventions. Complications included transient numbness, non-significant hematoma, ulnar artery perforation, and minor stroke in 15.5%, 13.3%, 2.2% and 2.2%, respectively. No major cardiac-cerebrovascular events or hand ischemia were noted. CONCLUSION Ulnar approach for coronary diagnostic or intervention procedures is a feasible alternative whenever radial route fails. It circumvents crossover to the femoral approach. Our study confirms satisfactory success rate of ulnar access in the presence of adequate ulnar pulse intensity and within acceptable rates of complications.
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Affiliation(s)
- Mansour Sallam
- Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat
| | - Adil Al-Riyami
- Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat
| | - Mohammad Misbah
- Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat
| | | | - Abdallah Al-Alawi
- Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat
| | - Aiman Al-Wahaibi
- Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat
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