Percutaneous Transulnar Arterial Approach for Coronary Interventions

Objectives: Coronary diagnostics and interventions have come a long way. For decades the femoral artery has been the access of choice , until radial artery was found to be a viable alternative for coronary and non coronary interventions. We present here our experiences and an analytical review of our transulnar journey, spanning nearly a decade of inhibitions and tentativeness of using it as an alternative , to an upfront route of choice based on arterial dominance. Materials and Methods: We did a retrospective analysis based on interventions done through the transulnar route between Jan 2015 and Dec 2023. Both the operators in the study were experts in transradial procedures with an experience of more than 5000 each radial procedures. Results: Arterial dominance was assessed by palpation , and was defined as the more intensely palpable pulse at the wrist. Ulnar dominance was seen in 57.6 percent of the cases. Spasm was encountered in the ulnar artery in just a single case, and 4 cases (2.6%) had loops and tortuosities. The mean fluoroscopy time for coronary angiography was 1.5 mins. Conclusion: Transulnar route is a safe and effective alternative to radial approach in coronary diagnostic and interventional procedures. The principle of arterial dominance at the wrist is a good way for selection of access routes.