Document Type : Original Article(s)


1 Associate Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Intervention Fellowship Practitioner, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran

5 Assistant Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: Transulnar approach was introduced as an alternative procedure for transradial coronary angiography (CAG) due to its safety and feasibility. The present study was accomplished with the aim to compare major and minor complications of these two upper extremity approaches in the population under study.METHODS: In this prospective observational study, 216 patients who underwent CAG and/or angioplasty via radial (111 cases) or ulnar artery (105 cases) were observed and followed for 6 months and were evaluated for major adverse cardiac events (MACEs), minor and major neurovascular events (access related) of the arm including paresthesia/pain, pseudoaneurysm, artery spasm, arterial occlusion, large hematoma, and necessity for amputation or emergency surgery.RESULTS: The majority of patients were men (62.1%) with a mean age of 59.98 ± 9.74 years old. No MACEs and major life threatening vascular complication like large hematoma, need for amputation or surgery, and hand ischemia were occurred. There was no significant difference in minor complications, except for arterial occlusion 9.0 % vs 1.0 % and artery spasm 12.6 % vs 1.9 % in transradial and transulnar approaches, respectively (P < 0.05).CONCLUSION: This study suggested that both transradial and transulnar approaches were safe and feasible for CAG and/or angioplasty. However, regarding minor complications, arterial spasm and occlusion were significantly more common in transradial approach. 


  1. Bruschke AV, Sheldon WC, Shirey EK, Proudfit WL. A half century of selective coronary arteriography. J Am Coll Cardiol 2009; 54(23): 2139-44.
  2. Sadeghi M, Sarrafzadegan N, Shahabi J, Hedayat P. The five-year trend of coronary artery diseases based on angiography results in central part of Iran. Iran Heart J 2018; 13(2): 12-9.
  3. Alvarez-Tostado JA, Moise MA, Bena JF, Pavkov ML, Greenberg RK, Clair DG, et al. The brachial artery: A critical access for endovascular procedures. J Vasc Surg 2009; 49(2): 378-85.
  4. Lotan C, Hasin Y, Mosseri M, Rozenman Y, Admon D, Nassar H, et al. Transradial approach for coronary angiography and angioplasty. Am J Cardiol 1995; 76(3): 164-7.
  5. Mann T, Cowper PA, Peterson ED, Cubeddu G, Bowen J, Giron L, et al. Transradial coronary stenting: Comparison with femoral access closed with an arterial suture device. Catheter Cardiovasc Interv 2000; 49(2): 150-6.
  6. Dashkoff N, Dashkoff PB, Zizzi JA Sr, Wadhwani J, Zizzi JA Jr. Ulnar artery cannulation for coronary angiography and percutaneous coronary intervention: Case reports and anatomic considerations. Catheter Cardiovasc Interv 2002; 55(1): 93-6.
  7. 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.
  8. Layton KF, Kallmes DF, Kaufmann TJ. Use of the ulnar artery as an alternative access site for cerebral angiography. AJNR Am J Neuroradiol 2006; 27(10): 2073-4.
  9. 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.
  10. Hahalis G, Tsigkas G, Xanthopoulou I, Deftereos S, Ziakas A, Raisakis K, et al. Transulnar compared with transradial artery approach as a default strategy for coronary procedures: A randomized trial. The Transulnar or Transradial Instead of Coronary Transfemoral Angiographies Study (the AURA of ARTEMIS Study). Circ Cardiovasc Interv 2013; 6(3): 252-61.
  11. 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.
  12. Bertrand OF, Larose E, Rodes-Cabau J, Gleeton O, Taillon I, Roy L, et al. Incidence, predictors, and clinical impact of bleeding after transradial coronary stenting and maximal antiplatelet therapy. Am Heart J 2009; 157(1): 164-9.
  13. Bertrand OF, De Larochelliere R, Rodes-Cabau J, Proulx G, Gleeton O, Nguyen CM, et al. A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation. Circulation 2006; 114(24): 2636-43.
  14. 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(3): 138-44.
  15. Louvard Y, Lefevre T. Loops and transradial approach in coronary diagnosis and intervention. Catheter Cardiovasc Interv 2000; 51(2): 250-2.
  16. Salim A, Ahsan SA, Siddique A, Banerjee SK, Rahman F, Ahmed CM, et al. Initial experience of coronary angiogram through trans ulnar route in Bangabandhu Sheikh Mujib Medical University. University Heart Journal 2013; 9(2): 80-2.
  17. Kiemeneij F, Laarman GJ. Percutaneous transradial artery approach for coronary stent implantation. Cathet Cardiovasc Diagn 1993; 30(2): 173-8.