The body of evidence for transradial approach (TRA) has become considerable over the last decade, and its advantages over the transfemoral approach have been well-described and include reduced bleeding, access-site complications, and mortality, as well as early ambulation, shorter hospital stays, and reduced cost [ ]. Unfortunately, not every patient is a candidate for radial access because of issues such as small artery size, anatomical features such as radial loops and subclavian tortuosity, excessive spasm or complete absence if harvested as an arterial conduit for coronary artery bypass grafting (CABG). These issues lead to the biggest limitation of TRA, which is a relatively high crossover rate, with real-world estimates of 4.6% to 10% crossover rate [ ]. The ulnar artery has been investigated as an alternative to the radial artery, as it presumably carries many of the same advantages. In addition, there are proposed advantages of transulnar access (TUA), which include larger vessel size, avoiding vascular trauma to the radial artery and, thus, preserving it as a conduit for future CABG or angiography. Generally, the ulnar artery is the larger of the two branches originating from the brachial artery and courses along the medial aspect of the forearm and just lateral to the ulnar nerve [ ]. There have been a few small, randomized control trials comparing TRA vs. TUA over the years. A 2016 meta-analysis of 5 trials by Dahal et al. [ ] demonstrated similar rates of major adverse cardiovascular events, access-related complications, access time, fluoroscopy time, and contrast volume. Of note, TUA compared to TRA was found to have a higher rate of access crossover (14% vs. 3.8%), as well as number of punctures (1.57 vs. 1.4).
Cardiovascular Revascularization Medicine Volume 26, May 2021, Pages 46-47
Read the full article on Science Direct: Editorial: Should Transulnar Access Gain the Upper Hand in 2021?