Sallam Mansour, Al-Riyami Adil, Misbah Mohammad, Al-Sukaiti Rashid, Al-Alawi Abdallah, Al-Wahaibi Aiman
Medicine Department, Cardiology Unit, Sultan Qaboos University Hospital, Muscat.
Radiology Department, Sultan Qaboos University Hospital, Muscat.
J Saudi Heart Assoc. 2014 Jul;26(3):138-44. doi: 10.1016/j.jsha.2014.01.003. Epub 2014 Feb 6.
To assess the feasibility and safety of transulnar approach whenever transradial access fails.
Radial access for coronary procedures has gained sound recognition. However, the method is not always successful.
Between January 2010 and June 2013, diagnostic with or without percutaneous coronary intervention (PCI) was attempted in 2804 patients via the radial approach. Transradial approach was unsuccessful in 173 patients (6.2%) requiring crossover to either femoral (128 patients, 4.6%) or ulnar approach (45 patients, 1.6%). Patients who had undergone ulnar approach constituted our study population. Selective forearm angiography was performed after ulnar sheath placement. We documented procedural characteristics and major adverse cardio-cerebrovascular events.
Radial artery spasm was the most common cause of crossover to the ulnar approach (64.4%) followed by failure to puncture the radial artery (33.4%). Out of 45 patients (82.2%), 37 underwent successful ulnar approach. The eight failed cases (17.8%) were mainly due to absent or weak ulnar pulse (75%). PCI was performed in 17 cases (37.8%), of which 8 patients underwent emergency interventions. Complications included transient numbness, non-significant hematoma, ulnar artery perforation, and minor stroke in 15.5%, 13.3%, 2.2% and 2.2%, respectively. No major cardiac-cerebrovascular events or hand ischemia were noted.
Ulnar approach for coronary diagnostic or intervention procedures is a feasible alternative whenever radial route fails. It circumvents crossover to the femoral approach. Our study confirms satisfactory success rate of ulnar access in the presence of adequate ulnar pulse intensity and within acceptable rates of complications.
评估在经桡动脉途径失败时经尺动脉途径的可行性和安全性。
冠状动脉介入手术的桡动脉途径已获得广泛认可。然而，该方法并非总能成功。
2010年1月至2013年6月期间，对2804例患者尝试经桡动脉途径进行诊断性或经皮冠状动脉介入治疗（PCI）。173例患者（6.2%）经桡动脉途径不成功，需要改用股动脉途径（128例患者，4.6%）或尺动脉途径（45例患者，1.6%）。接受尺动脉途径的患者构成了我们的研究人群。在置入尺动脉鞘后进行选择性前臂血管造影。我们记录了手术特征和主要的心脑血管不良事件。
桡动脉痉挛是改用尺动脉途径最常见的原因（64.4%），其次是桡动脉穿刺失败（33.4%）。45例患者中（82.2%），37例尺动脉途径成功。8例失败病例（17.8%）主要是由于尺动脉搏动消失或减弱（75%）。17例患者（37.8%）进行了PCI，其中8例患者接受了急诊介入治疗。并发症包括短暂性麻木、轻微血肿、尺动脉穿孔和轻度卒中，发生率分别为15.5%、13.3%、2.2%和2.2%。未观察到重大心脑血管事件或手部缺血。
当桡动脉途径失败时，冠状动脉诊断或介入手术的尺动脉途径是一种可行的替代方法。它避免了改用股动脉途径。我们的研究证实，在尺动脉搏动强度足够且并发症发生率可接受的情况下，尺动脉途径的成功率令人满意。
