Author + information
Background: Even amongst experienced radial operators, cross over to an alternate arterial access for coronary angiography is often to femoral or contralateral radial artery. For selected patients, the transulnar access (TUA) may be a more desirable approach, but concerns about its safety and efficacy have limited its adoption. The objective of this study is to assess the safety and efficacy of TRU vs TRA for diagnostic percutaneous coronary procedures.
Methods: Relevant studies comparing TUA to TRA were identified through electronic literature searches of MEDLINE, EMBASE and Cochrane. Access complications and clinical outcomes were compared. Heterogeneity between studies was also analyzed using the I2 statistics and displayed in forest plots.
Results: Seven studies involving 5566 patients were identified, 2782 patients underwent TUA and 2748 underwent TRA. MACE was similar between both groups (TUA 7.9% vs TRA 8.0%; odds ratio [OR] 0.98; 95% CI 0.80-1.2; I2 = 0%, p=0.83). There was no difference in overall access site complications 12.6% TUA v 12.8% TRA (OR 1.01; 95% CI 0.77-1.33; I2 = 47%, p=0.09); bleeding 2.6% TUA v 2.3% TRA (OR 1.14; 95% CI 0.81-1.61; I2 = 65%, p=0.008), or arterial occlusion 5.8% TUA v 6.0% TRA (OR 0.96; 95% CI 0.77-1.21; I2 = 7%, p=0.38). Notably, there was significantly higher crossover rates in the TUA arm; 9.0% TUA and 3.7% TRA (OR 2.19; 95% CI 0.93-5.17, I2 = 88%, p<0.00001). Rates of nerve injury was higher in the TUA group, 0.54% TUA v 0.04% TRA (OR 6.59 95% CI 1.74-24.98, I2 = 3%, p=0.38). A non-significant trend towards increased arterial spasm in the TRA group was seen, 7.2% TUA v 8.3% TRA (OR 0.85; 95% CI 0.69-1.05, I2 = 74%, p=0.002). There was no difference between contrast use and fluoroscopy time between groups. There was a trend towards increased arterial access time in TUA group (Mean difference, 0.33 (-0.19,0.80).
Conclusions: This meta-analysis suggests that TUA for coronary angiography is safe and may be a suitable option in selected patients when TRA is not technically not feasible or being preserved for coronary revascularization. TUA may mitigate complications associated with crossing over to femoral access when TRA fails
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: 1192-123
- 2017 American College of Cardiology Foundation