Transulnar ve Transradial Erişim Yöntemlerinin Post-CABG Hastalarında Koroner Anjiyografi Sırasındaki Etkinliği

Year 2025, Volume: 17 Issue: 3, 246 - 251, 29.10.2025

Ahmet Can Çakmak , Betül Sarıbıyık Çakmak , Perihan Varım , Yusuf Can , Havva Kocayigit

Abstract

Amaç Koroner arter bypass greftleme (CABG) öyküsü olan hastalar genellikle ileri yaş, ek hastalıklar ve yaygın ateroskleroz ile başvurur, bu da koroner anjiyografiyi daha karmaşık hale getirir. Geleneksel olarak transfemoral yol tercih edilirken, transradial erişim daha güvenli ve konforlu bir alternatif olarak öne çıkmıştır. Son zamanlarda, radial erişimin mümkün olmadığı durumlarda, transulnar erişim de ilgi görmeye başlamıştır. CABG geçirmiş hastalarda koroner anjiyografi sırasında transulnar ve transradial erişim yöntemlerinin etkinliğini ve güvenliğini karşılaştırmak.
Yöntemler Bu retrospektif, tek merkezli çalışmada, 2022 ile 2024 yılları arasında sol radial (n=18) veya sol ulnar (n=19) erişim yoluyla koroner anjiyografi yapılan 37 post-CABG hastası değerlendirildi. Hastaların demografik özellikleri, risk faktörleri, laboratuvar verileri, işlem parametreleri ve komplikasyonlar analiz edildi. Tüm işlemler 6 Fr kateterler ile gerçekleştirildi.
Bulgular Gruplar demografik özellikler, risk faktörleri ve laboratuvar bulguları açısından benzerdir. İşlem süresi, floroskopi süresi, radyasyon dozu veya kateter kullanımı açısından anlamlı bir fark saptanmadı. Ancak, ponksiyon süresi transradial grupta belirgin şekilde daha kısaydı (15.8 ± 8 dk vs. 28.2 ± 17 dk, p=0.007). Her iki grupta da majör komplikasyon gözlenmedi. Femoral geçiş oranı transulnar grupta daha yüksek olmasına rağmen, istatistiksel olarak anlamlı bulunmadı (21.1% vs. 0%, p=0.059).
Sonuç Transulnar erişim, CABG geçirmiş hastalarda koroner anjiyografi sırasında transradial erişime güvenli ve etkili bir alternatif sunmaktadır. Transulnar grupta ponksiyon süresi daha uzun olmasına rağmen, genel işlem başarısı ve güvenliği benzerdir. Radial erişimin sınırlı olduğu durumlarda, transulnar erişim özellikle yararlı olabilir.

Keywords

ulnar erişim , CABG , radyal erişim

Ethical Statement

Bu çalışma, Sakarya Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından 21 Ekim 2022 tarihinde onaylanmıştır (Onay No: E.16214662-050.01.04-176909-122). Çalışmaya katılan tüm bireylerden yazılı ve bilgilendirilmiş onam alınmıştır.

Transulnar Versus Transradial Access in Post-CABG Patients Undergoing Coronary Angiography

Abstract

Objective: Patients with a history of coronary artery bypass grafting (CABG) often present with advanced age, comorbidities, and diffuse atherosclerosis, making coronary angiography more complex. While the transfemoral route has been traditionally preferred, transradial access has emerged as a safer and more comfortable alternative. Recently, transulnar access has also gained interest, especially when radial access is not feasible. To compare the efficacy and safety of transulnar versus transradial access in CABG patients undergoing coronary angiography.
Method: In this retrospective, single-center study, 37 post-CABG patients who underwent coronary angiography between 2022 and 2024 via left radial (n=18) or left ulnar (n=19) access were evaluated. Baseline demographics, risk factors, laboratory data, procedural parameters, and complications were analyzed. All procedures were performed with 6 Fr catheters.
Results: The groups were comparable in terms of demographics, risk factors, and laboratory findings. There were no significant differences in procedure time, fluoroscopy duration, radiation dose, or catheter use. However, puncture time was significantly shorter in the transradial group (15.8 ± 8 vs. 28.2 ± 17 min, p=0.007). No major complications occurred in either group. Femoral crossover was more frequent in the transulnar group, though not statistically significant (21.1% vs. 0%, p=0.059).
Conclusions: Transulnar access is a safe and effective alternative to transradial access in CABG patients undergoing coronary angiography. While puncture time was longer in the transulnar group, overall procedural success and safety were comparable. Transulnar access may be especially useful when radial access is limited.

Keywords

transulnar , CABG , transradial

Ethical Statement

This study was approved by the Clinical Research Ethics Committee of Sakarya University on October 21, 2022 (Approval No: E.16214662-050.01.04-176909-122). Informed written consent was obtained from all study participants.

References

• 1. Cakmak AC, Kocayigit İ, Varım P, Çakmak BS, Can Y, Vatan MB. The effect of the systemic immune-inflammatory index on the no-reflow phenomenon in patients undergoing saphenous vein intervention. Postepy Kardiol Interwencyjnej. 2024;20(2):148-56.
• 2. Oliveira MDP, Navarro EC, Caixeta A. Distal transradial access for post-CABG coronary and surgical grafts angiography and interventions. Indian Heart J. 2021;73(4):440-5.
• 3. Hildick-Smith DJ, Walsh JT, Lowe MD, Petch MC. Coronary angiography in the fully anticoagulated patient: The transradial route is successful and safe. Catheter Cardiovasc Interv 2003;58:8–10.
• 4. Choussat R, Black A, Bossi I, Fajadet J, Marco J. Vascular complications and clinical outcome after coronary angioplasty with platelet IIb/IIIa receptor blockade. Comparison of transradial vs transfemoral arterial access. Eur Heart J. 2000;21:662–7.
• 5. Louvard Y, Ludwig J, Lefevre T, Schmeisser A, Bruck M, Scheinert D, et al. Transradial approach for coronary angioplasty in the setting of acute myocardial infarction: A dual-center registry. Catheter Cardiovasc Interv. 2002;55:206–11.
• 6. Philippe F, Larrazet F, Meziane T, Dibie A. Comparison of transradial vs. transfemoral approach in the treatment of acute myocardial infarction with primary angioplasty and abciximab. Catheter Cardiovasc Interv. 2004;61:67–73.
• 7. Aptecar E, Pernes JM, Chabane-Chaouch M, Bussy N, Catarino G, Shahmir A, et al. Transulnar versus transradial artery approach for coronary angioplasty: the PCVI-CUBA study. Catheter Cardiovasc Interv. 2006;67(5):711-20.
• 8. Jolly SS, Yusuf S, Cairns J, Niemelä K, Xavier D, Widimsky P, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377(9775):1409-20. Erratum in: Lancet. 2011;377(9775):1408. Erratum in: Lancet. 2011;378(9785):30.
• 9. Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet. 2015;385(9986):2465-76.
• 10. Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El-Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev. 2018;4:CD012318.
• 11. Ferrante G, Rao SV, Jüni P, Da Costa BR, Reimers B, Condorelli G, et al. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2016;9(14):1419-34.
• 12. Valgimigli M, Frigoli E, Leonardi S, Vranckx P, Rothenbühler M, Tebaldi M, et al. Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial. Lancet. 2018;392(10150):835-48.
• 13. Amro A, Mansoor K, Amro M, Hirzallah H, Sobeih A, Kusmic D, et al. Transradial Versus Transfemoral Approach for Coronary Angiography in Females with Prior Bypass Surgery. Cureus. 2020;12(1):e6797.
• 14. Gunduz Y, Gunduz H, Ayhan LT, Ciner M, Cakmak A, Saribiyik B, et al. The Ulnar Artery as a Favorable Primary or Alternative Access Site for Coronary Angiography and Interventions. Angiology. 2020;71(5):417-24.
• 15. Shafiq M, Mahmoud HB, Fanous ML. Percutaneous trans-ulnar versus trans-radial arterial approach for coronary angiography and angioplasty, a preliminary experience at an Egyptian cardiology center. Egypt Heart J. 2020;72(1):60.
• 16. Sedhom R, Megaly M, Abraham B, George JC, Kalra S, Janzer S. Transulnar Versus Transradial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials. Cardiovasc Revasc Med. 2021 May;26:39-45.
• 17. Groenland FT, Wilschut JM, van den Oord SC, Kardys I, Diletti R, de Jaegere PP, et al. Cardiac Catheterizations in Patients With Prior Coronary Bypass Surgery: Impact of Access Strategy on Short-Term Safety and Long-Term Efficacy Outcomes. Angiology. 2021;72(5):465-73.
• 18. Dahal K, Rijal J, Lee J, Korr KS, Azrin M. Transulnar versus transradial access for coronary angiography or percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Catheter Cardiovasc Interv. 2016;87(5):857-65.
• 19. Faisaluddin M, Sattar Y, Song D, Titus A, Erdem S, Alsaud A, et al. Cardiovascular Outcomes of Transulnar Versus Transradial Percutaneous Coronary Angiography and Intervention: A Regression Matched Meta-Analysis. Am J Cardiol. 2023;201:92-100.
• 20. Li YZ, Zhou YJ, Zhao YX, Guo YH, Liu YY, Shi DM, et al. Safety and efficacy of trans-ulnar approach for coronary angiography and intervention. Chin Med J (Engl) 2010;123:1774–1779.
• 21. Terashima M, Meguro T, Takeda H, Endoh N, Ito Y, Mitsuoka M, et al. Percutaneous ulnar artery approach for coronary angiography: a preliminary report in nine patients. Catheter Cardiovasc Interv. 2001;53(3):410-4.
• 22. Dashkoff N, Dashkoff PB, Zizzi JA Sr, Wadhwani J, Zizzi JA Jr. Ulnar artery cannulation for coronary angiography and percutaneous coronary intervention: case reports and anatomic considerations. Catheter Cardiovasc Interv. 2002;55(1):93-6.
• 23. Vogelzang RL. Arteriography of the hand and wrist. Hand Clin. 1991;7(1):63-86.
• 24. Roghani-Dehkordi F, Hadizadeh M, Hadizadeh F. Percutaneous trans-ulnar artery approach for coronary angiography and angioplasty: a case series study. ARYA Atheroscler. 2015;11(5):305–9.