The ulnar approach: a good alternative to the radial approach

The ulnar approach: a good alternative to the radial approach The percutaneous Seldinger technique using a femoral approach has been employed to perform cardiac catheterization for years, both for diagnostic and therapeutic procedures. The radial approach, developed in the last twenty years, is now preferred by many interventional cardiologists, particularly in France, because of its true advantages, namely easy hemostasis and consequently an extremely low incidence of complications at the access site, better patient comfort, shorter bed rest and lower hospitalization time and costs. The ulnar artery shares with the radial artery its easy access and hemostatic qualities and is often as large or larger than the radial artery. Previously ignored, in the last years some series and two randomized studies have shown that the ulnar approach for coronary (and some peripheral) interventions is possible, feasible, efficacious, and safe. In fact, the success rate using the ulnar approach is high and similar to that of radial approach. Moreover, local and systemic complications are extremely low and similar with both approaches. As in the radial approach, the ulnar approach requires a learning curve, which is rapidly accomplished by trained radial artery operators, and the presence of functional palmar archs (easily evaluated with Allen's test), avoids ischemic complications in case of thrombotic occlusion, which occurs in 3 to 5% of cases. The ulnar approach should not be forgotten by interventional cardiologists, who would appreciate feeling at ease with this technique, particularly in cases when the transradial access in not possible or fails, before reverting to the trans-femoral approach.