Ipsilateral transulnar catheterization in patients with ipsilateral radial artery occlusion.

Kwan TW, Ratcliffe JA, Chaudhry M, Huang Y, Wong S, Zhou Z, Pancholy S, Patel T.

BACKGROUND: 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. METHODS: Seventeen consecutive patients undergoing transulnar catheterization and PCI were reviewed. Each of the patients had clinical follow up post-procedure at day 1, day 7, and day 30. RESULTS: 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 day 1, day 7, and day 30. No patients developed with any signs or symptoms of hand ischemia during follow-up. CONCLUSION: 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.

Catheter Cardiovasc Interv. 2012 Sep 25