Document Type : Original Article(s)
Authors
- Farshad Roghani-Dehkordi 1
- Hossein Hosseinzadeh 1
- Mohammad Kermani-Alghoraishi 1
- Alireza Khosravi 1
- Mehrbod Vakhshoori 2
- Masoumeh Sadeghi 3
- Manizheh Danesh 4
- Nahid Sadeghi 5
- Davood Sahfie 2
1 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSION: 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.
Keywords
- Al-Azizi KM, Lotfi AS. The distal left radial artery access for coronary angiography and intervention: A new era. Cardiovasc Revasc Med 2018; 19(8S): 35-40.
- Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn 1989; 16(1): 3-7.
- Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: A comprehensive review of recent anatomic and physiologic investigations. Anesth Analg 2009; 109(6): 1763-81.
- Hetherington SL, Adam Z, Morley R, de Belder MA, Hall JA, Muir DF, et al. Primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction: Changing patterns of vascular access, radial versus femoral artery. Heart 2009; 95(19): 1612-8.
- Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial. Lancet 2011; 377(9775): 1409-20.
- 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(1): 42-8.
- Roghani F, Tajik MN, Khosravi A. Compare complication of classic versus patent hemostasis in transradial coronary angiography. Adv Biomed Res 2017; 6: 159.
- Roghani F, Shirani B, Hashemifard O. The effect of low dose versus standard dose of arterial heparin on vascular complications following transradial coronary angiography: Randomized controlled clinical trial. ARYA Atheroscler 2016; 12(1): 10-7.
- Valsecchi O, Vassileva A, Musumeci G, Rossini R, Tespili M, Guagliumi G, et al. Failure of transradial approach during coronary interventions: Anatomic considerations. Catheter Cardiovasc Interv 2006; 67(6): 870-8.
- Dehghani P, Mohammad A, Bajaj R, Hong T, Suen CM, Sharieff W, et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. JACC Cardiovasc Interv 2009; 2(11): 1057-64.
- Roghani-Dehkordi F, Hashemifard O, Sadeghi M, Mansouri R, Akbarzadeh M, Dehghani A, et al. Distal accesses in the hand (two novel techniques) for percutaneous coronary angiography and intervention. ARYA Atheroscler 2018; 14(2): 95-100.
- Terashima M, Meguro T, Takeda H, Endoh N, Ito Y, Mitsuoka M, et al. Percutaneous ulnar artery approach for coronary angiography: A preliminary report in nine patients. Catheter Cardiovasc Interv 2001; 53(3): 410-4.
- Roghani-Dehkordi F, Hadizadeh M, Hadizadeh F. Percutaneous trans-ulnar artery approach for coronary angiography and angioplasty; A case series study. ARYA Atheroscler 2015; 11(5): 305-9.
- 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 2016; 87(5): 857-65.
- Hsueh SK, Cheng CI, Fang HY, Omran MM, Liu WH, Chung WJ, et al. Feasibility and safety of transulnar catheterization in ipsilateral radial artery occlusion. Int Heart J 2017; 58(3): 313-9.
- Andrade PB, Tebet MA, Andrade MV, Labrunie A, Mattos LA. Primary percutaneous coronary intervention through transulnar approach: Safety and effectiveness. Arq Bras Cardiol 2008; 91(4): e49-4.
- Koutouzis M, Maniotis C, Agelaki M, Tzifos V, Matsoukis I, Lazaris E. Transulnar approach for coronary catheterization in patients with a harvested ipsilateral radial artery: A case series. Cardiovasc Revasc Med 2017; 18(5): 364-6.
- Zybulewski A, Edwards M, Kim E, Nowakowski FS, Patel R, Tabori N, et al. Transulnar approach as an alternative to transradial approach in non-
- coronary intervention: Safety, feasibility and technical factors. J Vasc Access 2017; 18(3): 250-4.
- Kedev S, Zafirovska B, Dharma S, Petkoska D. Safety and feasibility of transulnar catheterization when ipsilateral radial access is not available. Catheter Cardiovasc Interv 2014; 83(1): E51-E60.
- Kwan TW, Ratcliffe JA, Chaudhry M, Huang Y, Wong S, Zhou X, et al. Transulnar catheterization in patients with ipsilateral radial artery occlusion. Catheter Cardiovasc Interv 2013; 82(7): E849-E855.
)