scholarly journals Coronary angiography through ipsilateral ulnar approach in a patient with small-diameter radial artery

2013 ◽  
Vol 66 (5-6) ◽  
pp. 245-249
Author(s):  
Zoran Stajic ◽  
Zdravko Mijailovic
Keyword(s):  
Coronary Angiography ◽  
Radial Artery ◽  
Small Diameter ◽  
Ulnar Artery ◽  
Effective Alternative ◽  
Alternative Approach ◽  
Coronary Procedures ◽  
Sheath Insertion ◽  
The Right

Introduction. Coronary procedures cannot be completed in 5-15% of cases through initially used radial artery approach due to frequent radial artery anomalies and vasospasm. In these cases, the ulnar artery approach could be the safe and effective alternative wrist approach. Case report. A 60-year-old patient with stable angina pectoris, hypertension, dyslipidaemia and positive endurance test was admitted to our hospital for coronary angiography. Due to the backbone pains which also made prolonged lying in bed very uncomfortable and painful, we opted for the wrist approach (standard radial approach) after both modified Allen?s tests had been performed, which gave the positive result. After sheath insertion into the right radial artery and unsuccessful advancement of the guidewire and the catheter, we performed the right forearm angiography, which revealed that the right radial artery had a small diameter and the right ulnar artery was the dominant one. Afterwards, the right ulnar artery was cannulated successfully and the coronary angiography was performed through this approach. Both sheaths were removed simultaneously immediately after the procedure and hemostasis was secured by the compression with two Terumo- bands over the puncture sites without any complications. The pulses of both arteries were checked regularly over the next 24 hours and they remained normal. A day after the procedure, the control Doppler-ultrasound check-up was performed and it confirmed the normal flow in both cannulated arteries. One-month follow-up was uneventful, and the patient did not experience any ischemic symptoms of the hand. Conclusion. This case is the proof that the ipsilateral ulnar approach can be a safe and effective alternative approach in patients with positive Allen?s test after the failure of initial radial attempt in cases where femoral approach should be avoided or the wrist approach should be maintained.

scholarly journals Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Mohammad Shafiq ◽  
Hesham Boushra Mahmoud ◽  
Malak Lamie Fanous
Keyword(s):  
Coronary Angiography ◽  
Radial Artery ◽  
Ulnar Artery ◽  
Coronary Intervention ◽  
Radial Approach ◽  
Percutaneous Coronary ◽  
Procedural Time ◽  
Coronary Procedures ◽  
Doppler Evaluation ◽  
The Right

Abstract Background Trans-ulnar approach was proposed primarily for elective procedures in patients not suitable for trans-radial approach that was introduced two decades ago. The trans-ulnar approach is as safe and effective as the trans-radial approach for coronary angiography and intervention. Aim This study’s aim was to assess the feasibility and safety of the trans-ulnar approach in coronary procedures as a preliminary experience for operators experienced in trans-radial approach with no/minimal trans-ulnar approach experience at an Egyptian center. Results Vascular access in 120 patients was selected randomly for coronary angiography and angioplasty—80 through radial and 40 through ulnar approach. Patients were examined for local complications and Doppler evaluation to both radial and ulnar arteries a day after the procedure was done. Ulnar approach success was 82.5% versus 93.7% in the radial group; failure of ulnar artery puncture was the only cause of crossover in the ulnar group, while occurrence of persistent spasm was the leading cause of crossover in the radial group followed by radial artery tortuosity. The procedure time of coronary angiography and percutaneous coronary intervention of the ulnar group was significantly higher than that of the radial group (P value = 0.011 and 0.034, respectively). The mean caliber of the right ulnar artery was 2.45 ± 0.38, slightly larger than that of the radial artery 2.33 ± 0.38 at the level of the wrist, but this difference was statistically non-significant. Conclusion Our study demonstrated that ulnar access with experienced radial operators and in our patients is a safe and practical approach for coronary angiography or angioplasty, without any major complications. Bearing in mind its high success rate, it can be used when a radial artery is not useful for the catheterization or as a default approach on the expense of slightly longer procedural time.

scholarly journals A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion—The RESCUE-RAO Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Dmitrii V. Ognerubov ◽  
Alexander Sedaghat ◽  
Sergey I. Provatorov ◽  
Andrey S. Tereshchenko ◽  
Olivier F. Bertrand ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Randomized Trial ◽  
Hospital Discharge ◽  
Radial Artery ◽  
Ulnar Artery ◽  
Artery Occlusion ◽  
Puncture Site ◽  
Coronary Procedures ◽  
Baseline Characteristics ◽  
Radial Artery Occlusion

Background. Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective. We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results. One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group ( p < 0.001 ). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group ( p < 0.001 ). Conclusion. Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

P6523Radial artery occlusion: predictors, methods for reducing the frequency of complications-a single center study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Ognerubov ◽  
A Tereshchenko ◽  
E Merkulov ◽  
S Provatorov ◽  
G Arutyunyan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Stable Coronary Artery Disease ◽  
Ulnar Artery ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Careful Examination ◽  
Radial Access ◽  
Short Time

Abstract Radial access has great advantages in terms of the frequency of complications, but it has one specific complication - radial artery occlusion (RAO). This complication often does not manifest itself in any way; however, it limits the use of access for the future interventions. Aim To compare methods of short and traditional hemostasis and to identify the main predictors of RAO after radial access. Materials and methods During the period from 2012 to 2018, 2000 patients were included in the study, which consisted of two parts: prospective - 1000 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) with stable coronary artery disease, and retrospective part of the study, which included 1000 patients admitted for PCI from other clinics. In a prospective study, patients were divided into two groups: after coronary angiography and PCI, respectively (n=500 in the coronary angiography group and n=500 in the PCI group), and then randomized. Hemostatic bandages in the first group of patients (n=250) were removed after 12–24 hours, in the second group (n=250) - after 4±1 hours. When the occlusion of the radial artery was detected, all patients underwent an hour-long compression of the ipsilateral ulnar artery to recanalize acute RAO. Results The frequency of RAO in the retrospective part of the study was 21.8%. The frequency of RAO in the prospective part of the study was 10.2% with a traditional time hemostasis and 1.4% with a short-time compression (P<0.001). Predictors of the RAO are illustrated in table 1. Predictors of bleeding were PCI (OR 0.12, 95% CI 0.01–0.67, P=0.05) and weight (OR 1.09, 95% CI 1.02–1.18, P=0.01). Table 1. Predictors of RAO Variables Odds ratio 95% Confidential interval Significance, P Traditional-time hemostasis 8.78 4.2–21.5 <0.001 Diabetes mellitus+smoking 18.1 12.7–26.7 <0.001 Diabetes mellitus 0.45 0.25–0.83 0.009 Body mass index 0.95 0.91–0.99 0.02 Male 1.75 1.01–3.18 0.05 Protein C 0,86 0,75–0,96 0,01 Conclusion Careful examination of the patient for detecting RAO before and after interventions is essential. Short hemostasis with compression of the ipsilateral ulnar artery reduce the frequency of RAO. For short-time hemostasis, special attention should be paid to patients after PCI and with low BMI, as far as these factors are associated with a greater risk of bleeding after removal of the compression bandage.

Comparison of Verapamil versus Heparin as Adjunctive Treatment for Transradial Coronary Procedures: The VERMUT Study

Cardiology ◽  
2018 ◽  
Vol 140 (2) ◽  
pp. 74-82 ◽  
Author(s):  
Matteo Tebaldi ◽  
Simone Biscaglia ◽  
Carlo Tumscitz ◽  
Annamaria Del Franco ◽  
Francesco Gallo ◽  
...  
Keyword(s):  
Radial Artery ◽  
Primary Outcome ◽  
Study Groups ◽  
Adjunctive Treatment ◽  
Access Site ◽  
Double Blind ◽  
Access Site Complication ◽  
Heparin Administration ◽  
Coronary Procedures ◽  
Sheath Insertion

Objective: We sought to demonstrate that the combination of a local vasodilator (verapamil), modern materials, patent hemostasis, and intravenous anticoagulant only in the case of percutaneous coronary intervention, as compared to default heparin administration after sheath insertion, may optimize a combined endpoint, including radial artery oc­clusion (RAO), radial artery spasm (RAS), and access site complication. Methods: This is a prospective, single-center, double-blind randomized trial. Overall, 418 patients undergoing a transradial approach (TRA) for coronary procedures were randomized 1: 1 to receive intraradial verapamil (5 mg) or heparin (5,000 IU) after a 6-Fr sheath insertion. The primary outcome was the 24-h occurrence of RAO (ultrasound confirmation), access site complication, and RAS requiring the bailout administration of vasodilators. Results: The combined primary outcome occurred in 127 (30%) patients. It was significantly lower in patients randomized to verapamil as compared to others (26 vs. 35%, p = 0.03). This was mainly due to a significant reduction in RAS (3 vs. 10%, p = 0.006). The 24-h and 30-day occurrence of RAO did not differ between the study groups. Conclusion: Local administration of verapamil versus heparin reduces RAS, without increasing RAO, which appears to be strictly related to radial artery diameter and hemostasis time.

Randomised comparison of JUDkins vs. tiGEr catheter in coronary angiography via the right radial artery: the JUDGE study

2018 ◽  
Vol 13 (16) ◽  
pp. 1950-1958 ◽  
Author(s):  
Ioanna Xanthopoulou ◽  
Katerina Stavrou ◽  
Periklis Davlouros ◽  
Grigorios Tsigkas ◽  
Eleni Koufou ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Radial Artery ◽  
The Right

Crossover Alternatives of Default Right Radial Artery Access for Acute Myocardial Infarction Intervention

2017 ◽  
Vol 71 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Oliver Kalpak ◽  
Hristo Pejkov ◽  
Gjorgji Kalpak ◽  
Marija Jovanoska ◽  
Biljana Zafirovska ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Radial Artery ◽  
Ulnar Artery ◽  
Coronary Intervention ◽  
Procedure Time ◽  
Access Site ◽  
X Ray ◽  
Crossover Rate ◽  
First Choice ◽  
The Right

Abstract Introduction. Being a default transradial access center we have encountered the need for alternative to the right radial artery. Determining the most frequent alternative access strategy for PCI in STEMI patientswasthe focus of our study. We sought to analyze whether the wrist access strategy impacts procedure time and success rate particularly for the STEMI interventions where time is of paramount importance. Methods. During four years, in our Center 2624 consecutive all-comers STEMI patients underwent urgent coronary intervention. TRA was used as the first-choice access strategy. We sought to assess crossover rate and safety of preferable access strategy. Crossover occurred according to the operator's decision. Primary outcomes were: access site crossover rate and In Lab time, secondary outcomes were PCI time, X-ray time, mortality and MACE at 30 days and at 6 months. Results. Overall crossover rate from default radial was 5.4% (144 out of 2624 patients). We treated 98.7% (2589) patients by wrist access and only 1.3% (35) patients with TFA. Crossover towards left radial occurred in 47.9% (69 out of 144 patients), towards ulnar 27.8% (40 patients) and towards TFA only 24.3% (35 patients). The meanIn-Lab time 40.4±17.7 minutes, PCI time was 21.4±7.4 min, X-ray time 9.2±4.7 minutes. Survival outcomes at 30 days were: MACE rate of 6.6% (174 patients), mortality rate of 5.0% (131 patients). At six months MACE rate was 8.6% and mortality rate was 5.6%. Conclusions. Default radial access is associated with alow crossover rate. Crossover towards femoral occurred less frequent than ulnar artery access.Complete wrist access strategy is safe and feasible for STEMI interventions with low mortality and MACE rate in unselected all-comers cohort.

Comparison of Clinical Value between Right Distal Radial Artery Access and Right Radial Artery Access in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Jianhua Fan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Access Time ◽  
Arterial Access ◽  
Compression Time ◽  
Percutaneous Coronary ◽  
The Right ◽  
Distal Radial Artery

Objective: To compare the feasibility and safety between right distal radial artery access and right radial artery accessin patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods: On the basis of arterial access, 113 patients who underwent CAG or PCI in Kunshan Hospital of TraditionalChinese Medicine between January and October 2018 were divided into two groups: a right distal radial artery group (52 patients) and a right radial artery group (61 patients). We collected general information, the number of puncture attempts, access times, postoperative compression time, and complications.Results: The general characteristics, rate of successful radial artery puncture, and rate of successful catheter placement inthe two groups were not different. The right radial artery group had fewer puncture attempts (1.26 ± 0.44 times vs. 2.19 ± 0.53times, P = 0.001) and a shorter access time (3.23 ± 0.86 min vs. 4.77 ± 1.49 min, P = 0.001) than the right distal radial arterygroup. However, the postoperative compression time in the right distal radial artery group was shorter (3.44 ± 0.9 h vs.7.16 ± 1.21 h, P = 0.001). Two cases of bleeding, four cases of hematoma, and one case of artery occlusion in the right radialartery group and one case of hematoma in the right distal artery group occurred before discharge. The rate of total complicationsin the right distal radial artery group was lower than in the right radial artery group (1.93% vs. 11.48%, P = 0.048).Conclusion: CAG or PCI through the right distal radial artery is feasible and safe.

Proximal Ulnar Artery Arteriovenous Fistula Inflow is an Uncommon but useful Vascular access Option

2017 ◽  
Vol 18 (6) ◽  
pp. 488-491 ◽  
Author(s):  
William C. Jennings ◽  
Alexandros Mallios
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Vascular Access ◽  
Ulnar Artery ◽  
Allen’S Test ◽  
Brachial Vein ◽  
Anatomic Variants ◽  
Allen's Test ◽  
Doppler Evaluation

Introduction A proximal ulnar artery arteriovenous fistula (PUA-AVF) is a logical vascular access option when the distal ulnar artery is occluded or inadequate in addition to other specific vascular anatomic variants. This study reviews a series of patients where the proximal ulnar artery was used for AVF inflow in establishing a reliable autogenous access for these uncommon patients. Materials and methods All new patients referred for vascular access with a PUA-AVF created during an eight-year period were evaluated. In addition to physical and ultrasound examinations, all patients had an Allen's test performed augmented with Doppler evaluation of the palmer arch. Analysis placed these patients into three anatomic groups: 1) A dominant radial artery with distal ulnar artery occlusive disease; 2) No cephalic or basilic vein option with an isolated and intact brachial vein originating from the ulnar vein for later staged transposition; 3) A proximal radial artery ≤2 mm in diameter and a normal Doppler augmented Allen's test. Results PUA-AVFs were created in 32 new patients during an eight-year period. Primary and cumulative patency rates were 80% and 94% at 12 months and 55% and 81% at 36 months. Follow-up was 2-62 months (mean 14 months). No patients developed steal syndrome during the study period. Conclusions A PUA-AVF is a safe and reliable autogenous access. It is particularly important when the radial artery is the only or dominant arterial supply to the hand, in patients with small but patent radial arteries, and in selected individuals requiring a brachial vein transposition.

scholarly journals Comparison of Safety and Efficiency between Tiger-2 Catheter with Right Radial Artery Access and Judkins Catheter with Left Radial Artery Access

2021 ◽  
Vol 10 (17) ◽  
pp. 4020
Author(s):  
Katarzyna Klimek ◽  
Mateusz Świątek ◽  
Konrad Klocek ◽  
Michał Tworek ◽  
Maciej Zwolski ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Radiation Exposure ◽  
Radial Artery ◽  
Statistical Difference ◽  
Radiation Dosage ◽  
Access Site ◽  
Radial Access ◽  
Baseline Characteristics ◽  
The Right ◽  
Left Radial Artery

We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast.

scholarly journals Use of ViperSlide Lubricant to Extract Entrapped Sheath after Severe Radial Artery Spasm during Coronary Angiography

2018 ◽  
Vol 45 (3) ◽  
pp. 186-187 ◽  
Author(s):  
Erica Fidone ◽  
Justin Price ◽  
Rajiv Gupta
Keyword(s):  
Coronary Angiography ◽  
General Anesthesia ◽  
Radial Artery ◽  
Nerve Block ◽  
Cardiac Catheterization ◽  
Arterial Spasm ◽  
Vasodilator Therapy ◽  
Removal Method ◽  
The Right ◽  
Blood Aspiration

Radial artery spasm is a known complication of transradial cardiac catheterization. However, severe spasm with sheath entrapment is rare. We describe such a case, and the condition's response to an alternative removal method after conventional efforts failed. A 68-year-old man presented for coronary angiography. We introduced a 5F sheath into the right radial artery, but, because of severe arterial spasm, we could not aspirate blood from the sheath or retract it. We sedated the patient and waited for the spasm to subside; however, the radial sheath remained entrapped. Nitroglycerin injection enabled blood aspiration and vasodilator injection, but not sheath removal. Finally, we injected ViperSlide lubricant into the sheath for its rapid, easy extraction. When sedation and vasodilator therapy fail, we recommend using ViperSlide for radial sheath removal before applying nerve block or general anesthesia.

Sign in / Sign up

Export Citation Format

Share Document