Santa Casa de Marília, Marília, São Paulo, Brazil.
Am Heart J. 2012 Oct;164(4):462-7. doi: 10.1016/j.ahj.2012.08.001.
Unsuccessful radial artery puncture, inability to advance the guide catheter to the ascending aorta, and inadequate guide catheter support represent mechanisms of transradial approach failure. With the rationale of sharing the same efficacy and safety promoted by radial access, the transulnar approach represents an alternative access site for percutaneous coronary procedures.
Between May 2007 and May 2012, 11,059 coronary invasive procedures were performed in a single institution: 10,108 by transradial approach (91.4%), 541 by transfemoral approach (4.9%), and 410 by transulnar approach (3.7%). Patients who underwent coronary procedures through transulnar access were included in a prospective registry of effectiveness and safety.
Diagnostic procedures accounted for 71.8% of cases, and the right ulnar access was the most common route (88.9%). Procedure success was high (98.5%), with a crossover rate of 1.5% (6 cases), of which 5 were achieved through the contralateral radial access and 1 through femoral approach. Complications related to access site were low (3.9%), consisting mostly of minor bleeding due to subcutaneous hematomas. There were no cases of major bleeding, nerve injury, pseudoaneurysm, arteriovenous fistula, or necessity of vascular surgical repair.
The transulnar approach represents an alternative to the transradial approach in selected cases when performed by radial-trained operators, sharing a high success rate and extremely low incidence of access-site complications.
桡动脉穿刺失败、导引导管无法进入升主动脉以及导引导管支撑不足是经桡动脉入路失败的机制。基于桡动脉入路的相同疗效和安全性，经尺动脉入路是经皮冠状动脉介入治疗的另一种入路选择。
在一家机构中，2007 年 5 月至 2012 年 5 月期间共进行了 11059 例冠状动脉介入治疗：10108 例经桡动脉入路（91.4%），541 例经股动脉入路（4.9%），410 例经尺动脉入路（3.7%）。接受经尺动脉入路冠状动脉介入治疗的患者被纳入有效性和安全性的前瞻性登记研究。
诊断性操作占 71.8%，右侧尺动脉入路最常见（88.9%）。手术成功率高（98.5%），交叉率为 1.5%（6 例），其中 5 例通过对侧桡动脉入路，1 例通过股动脉入路实现。与入路部位相关的并发症发生率低（3.9%），主要为皮下血肿引起的轻微出血。无大出血、神经损伤、假性动脉瘤、动静脉瘘或需要血管外科修复的病例。
经桡动脉入路培训的术者进行经尺动脉入路是桡动脉入路的一种替代方法，成功率高，且并发症发生率极低。
