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.