Beth Israel Medical Center, New York, New York; SUNY Downstate Medical Center at Long Island College Hospital, Brooklyn.
Catheter Cardiovasc Interv. 2013 Dec 1;82(7):E849-55. doi: 10.1002/ccd.24662. Epub 2013 Mar 14.
The transradial approach to percutaneous coronary intervention (PCI) has recently gained popularity among interventionalists. However, radial artery occlusion (RAO) limits the ability for repeat catheterization. In current practice, transulnar catheterization is thought to be a contraindication in patients with ipsilateral RAO.
Seventeen consecutive patients undergoing transulnar catheterization and PCI were reviewed. Each of the patients had clinical follow-up post-procedure at days 1, 7, and 30.
We successfully performed 17 ulnar catheterizations in patients with ipsilateral RAO. All patents were subsequently found to have adequate collaterals from the anterior interosseous branch. One patient developed ulnar artery spasm and another patient developed a forearm hematoma. Overall, no patient suffered any ulnar nerve injury. The ulnar artery was patent both by palpation and by the presence of an adequate plethysmographic signal during follow-up at days 1, 7, and 30. No patients developed with any signs or symptoms of hand ischemia during follow-up.
In patients with RAO, ipsilateral transulnar catheterization may not be an absolute contraindication. Our results suggest that extensive collaterals from the anterior interosseous artery may be the reason for protection against hand ischemia in the setting of RAO.
经皮冠状动脉介入治疗（PCI）的桡动脉入路最近在介入治疗医生中越来越受欢迎。然而，桡动脉闭塞（RAO）限制了重复进行导管插入术的能力。在当前的实践中，认为在同侧 RAO 患者中经尺动脉入路是禁忌的。
回顾了 17 例连续接受经尺动脉入路和 PCI 的患者。每位患者在术后第 1、7 和 30 天进行临床随访。
我们成功地对 17 例同侧 RAO 患者进行了尺动脉置管。所有患者随后均发现从前骨间动脉有足够的侧支循环。1 例患者发生尺动脉痉挛，另 1 例患者发生前臂血肿。总的来说，没有患者发生任何尺神经损伤。在术后第 1、7 和 30 天的随访中，通过触诊和适当的体积描记信号均可以发现尺动脉通畅。在随访期间，没有患者出现手部缺血的任何迹象或症状。
在 RAO 患者中，同侧经尺动脉置管术可能不是绝对禁忌证。我们的结果表明，从前骨间动脉广泛的侧支循环可能是 RAO 情况下防止手部缺血的原因。
