Coronary angiography and angioplasty are commonly performed through the radial artery at the wrist as this approach is associated with fewer bleeding complications and faster recovery. In some patients, the radial artery becomes occluded after prior procedures, requiring selection of an alternative access site for future coronary interventions.
The ulnar artery is a potential alternative wrist access. However, limited data are available on the safety of using the ulnar artery in the same arm as an occluded radial artery and on the possible effects on hand strength, sensation, and daily hand function.
The goal of this observational study is to evaluate the safety of transulnar access and its effect on hand function in adults with ipsilateral radial artery occlusion undergoing coronary angiography or angioplasty.
The main questions addressed by the study are:
* How often do serious access-related vascular or nerve complications occur? * Does hand strength, sensation, or functional use of the hand change during follow-up? * Does the ulnar artery remain patent after the procedure? The choice of vascular access site is made by the treating physician based on clinical judgment. Participants who undergo transulnar access will undergo follow-up assessments, including ultrasound evaluation of arm arteries, standardized hand function testing, and short questionnaires assessing upper-limb function.
The findings of this study are expected to inform access-site selection, improve patient counseling, and support safer care for patients with radial artery occlusion undergoing coronary procedures.
Adults aged 18 years or older
Documented radial artery occlusion in the upper limb intended for vascular access, confirmed by ultrasound or angiography
Scheduled to undergo elective coronary angiography and/or angioplasty
Transulnar arterial access on the same side as the occluded radial artery is selected by the treating physician
Inadequate or absent ulnar artery flow at the intended access site on ultrasound
Known ulnar nerve injury or neuropathy affecting the access-side upper limb
Severe pre-existing motor or sensory dysfunction of the access-side hand that would interfere with functional assessment
Emergency coronary procedures that preclude baseline vascular or functional assessment
Participants are recruited from cardiac catheterization laboratories and cardiology services of two tertiary-care public hospitals in Greece, including high-volume referral centers performing invasive coronary procedures. The study population represents adults undergoing routine elective coronary angiography or angioplasty in these hospital settings, where vascular access decisions are made as part of standard clinical practice.
Cohort
Prospective
Not listed
Incidence of Serious Access-Related Vascular and Clinical Neuromuscular Complications
Composite incidence of serious vascular and clinical neuromuscular complications attributable to transulnar arterial access ipsilateral to radial artery occlusion. Serious vascular events include acute hand ischemia, symptomatic ulnar artery occlusion, flow-limiting dissection requiring treatment, pseudoaneurysm or arteriovenous fistula requiring intervention, major access-site hematoma, or major bleeding. Clinical neuromuscular events include new, clinically evident motor or sensory deficits in the ulnar nerve distribution that persist or require targeted therapy.
Number of Access Attempts
Number of puncture attempts required to obtain successful vascular access
Technical Success Without Access-Site Crossover
Successful completion of coronary angiography or angioplasty via intended transulnar access without conversion to an alternative vascular access site.
Procedure Duration
Total procedural time from vascular access to sheath removal
Ulnar Artery Patency
Assessment of ulnar artery patency and flow characteristics using color duplex ultrasonography, including presence of antegrade flow and absence of occlusion or flow-limiting abnormalities.
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