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CROSSOVER FROM RADIAL TO IPSILATERAL ULNAR ARTERY: A SAFE AND FEASIBLE ALTERNATIVE IN COMPLEX RADIAL ARTERY ANATOMY
1168 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology CROSSOVER FROM RADIAL TO IPSILATERAL ULNAR ARTERY: A SAFE AND FEASIBLE ALTERNATIVE IN COMPLEX RADIAL ARTERY ANATOMY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Vascular Access and Hemostasis Issues Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications Presentation Number: 1192-129 Authors: Nagaraja Moorthy, Rajiv Ananthakrishna, Dattatreya P. V., Rangaraj Ramalingam, Manjunath C. N., Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
Background: Failed transradial approach(TR) is observed in up to 5% of the patients due to various anatomical reasons. In such selected cases, crossover to the ipsilateral ulnar artery (TU) may be considered. Objective of the Study: To study the safety and feasibility of crossover from transradial to ipsilateral transulnar access in difficult radial artery anatomy. Methods: Prospective observational study included 18 patients undergoing ipsilateral transulnar crossover after failed radial access.
Results: Challenging radial artery anatomy: Uncrossable radial artery loop was noted in 8 patients. Six had high radial artery take off (2 from subclavian artery, 4 from brachial artery) and 4 had diffuse caliber radial artery.
Procedure: When the catheter or wire advancement failed the anatomy of radial, ulnar and brachial artery were studied using injection (Figure 1A-F). In all cases ulnar artery anatomy was favorable. The radial sheath (6F Terumo) was left in situ and Ulnar artery access(Figure-1G) was obtained and sheath was inserted. The diagnostic coronary angiography was done in all and 6 cases underwent adhoc angioplasty. After the procedure both sheaths were removed achieving proper haemostasis (Picture-1H). In all 18 cases transulnar procedure was successful with no procedure related complications like bleeding, haematoma or ischemia.
Conclusions: Crossover to ipsilateral transulnar access after transradial failure strictly due to anomalies of the radial artery is feasible and safe.
Interventional Cardiology CROSSOVER FROM RADIAL TO IPSILATERAL ULNAR ARTERY: A SAFE AND FEASIBLE ALTERNATIVE IN COMPLEX RADIAL ARTERY ANATOMY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Vascular Access and Hemostasis Issues Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications Presentation Number: 1192-129 Authors: Nagaraja Moorthy, Rajiv Ananthakrishna, Dattatreya P. V., Rangaraj Ramalingam, Manjunath C. N., Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
Background: Failed transradial approach(TR) is observed in up to 5% of the patients due to various anatomical reasons. In such selected cases, crossover to the ipsilateral ulnar artery (TU) may be considered. Objective of the Study: To study the safety and feasibility of crossover from transradial to ipsilateral transulnar access in difficult radial artery anatomy. Methods: Prospective observational study included 18 patients undergoing ipsilateral transulnar crossover after failed radial access.
Results: Challenging radial artery anatomy: Uncrossable radial artery loop was noted in 8 patients. Six had high radial artery take off (2 from subclavian artery, 4 from brachial artery) and 4 had diffuse caliber radial artery.
Procedure: When the catheter or wire advancement failed the anatomy of radial, ulnar and brachial artery were studied using injection (Figure 1A-F). In all cases ulnar artery anatomy was favorable. The radial sheath (6F Terumo) was left in situ and Ulnar artery access(Figure-1G) was obtained and sheath was inserted. The diagnostic coronary angiography was done in all and 6 cases underwent adhoc angioplasty. After the procedure both sheaths were removed achieving proper haemostasis (Picture-1H). In all 18 cases transulnar procedure was successful with no procedure related complications like bleeding, haematoma or ischemia.
Conclusions: Crossover to ipsilateral transulnar access after transradial failure strictly due to anomalies of the radial artery is feasible and safe.