ABSTRACT:
Background: The transulnar method of coronary angiography was becoming an alternative to the conventional transradial and transfemoral access, especially in a patient with difficult vascular anatomy or radial artery occlusions. The benefits of this method included that the radial artery could be preserved in the future to be used in other procedures and the possibility of a reduction in access-site bleeding. But the apprehension was that it had a complication profile, which included vascular spasm, hematoma, arterial occlusion, and nerve damage. It was also important to assess these complications in order to determine the safety and viability of the transulnar route in the daily clinical practice.
Objective: This was done in order to establish the occurrence and nature of complications related to the transulnar approach among patients undergoing the coronary angiography procedure.
Methods: The study was a descriptive and cross-sectional case study that was done at the Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) between August 2024 and May 2025. One hundred and twenty patients undergoing coronary angiography were used as the sample population using the transulnar approach. A non-probability consecutive sampling method was used to select the patients. Patients who had ulnar artery disfigurements, undergone prior ulnar artery operations or had severe peripheral arterial disease were excluded. All the procedures were conducted by certified experienced interventional cardiologists under the local anesthesia and normal catheterization guidelines. Procedural success, complications data, such as hematoma, arterial spasm, occlusion, pseudoaneurysm, arteriovenous fistula and sensory deficit were recorded. The presence of complications was evaluated right after the procedure and 24 hours follow-up. Statistical analysis was carried out by use of the SPSS version 26.0 and findings presented in frequencies and percentages.
Results: Of 120 patients, 110 (91.7) patients successfully completed the procedure through the transulnar approach with 10 (8.3) patients having to crossover to the transradial or transfemoral route because of technical problems. In 22 (18.3) patients, minor complications were seen. Localized hematoma occurred in 10 (8.3) cases, arterial spasm in 6 (5) and transient sensory numbness 4 (3.3) patients, respectively, and indicated the most frequent complication. Major complications like arterial occlusion were noted in 2 (1.7%) of patients, there was no pseudoaneurysm or arteriovenous fistula. The majority of the complications could be controlled without surgical intervention.
Conclusion: Transulnar method of coronary angiography was revealed as a safe and feasible procedure in comparison to transradial one and with low rate of major complications. The minor problems like hematoma and spasm were fairly frequent, but were mostly mild in nature and self-limiting. The transulnar approach can be a good alternative, in case the operator has sufficient experience and has been careful when choosing patients, especially those whose radial artery is not available.
Keywords: Transulnar approach, coronary angiography, vascular complications, hematoma, arterial spasm, ulnar artery, interventional cardiology.