Koroner Anjiyografi Uygulanan Koroner Bypass Geçirmiş Hastalarda Transulnar ve Transradial Girişim Yöntemlerinin Karşılaştırılması

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. Yöntem: 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
• Koroner Anjiyografi
• Vasküler Girişim Komplikasyonları

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
• Coranary Angiography
• Vascular Access Complications

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