Clinical Outcomes and Vascular Safety of the Distal Transulner Approach for Coronary Angiography and Angioplasty

Background: The transradial approach has become the standard access for coronary angiography and intervention, yet limitations such as radial artery occlusion, spasm, and vessel loss for future grafting necessitate alternative access routes. The distal transulnar approach, utilizing the superficial palmar branch of the ulnar artery, has recently emerged as a promising option due to its favorable anatomy and collateral circulation.
Objective: To evaluate the feasibility, procedural performance, and vascular safety of the distal transulnar approach for coronary angiography and PCI.
Patients and Methods: This prospective observational study included 45 adult patients undergoing diagnostic or interventional coronary procedures via the distal transulnar route. Primary endpoints were procedural success, sheath insertion time, hemostasis time, and vascular patency. Secondary endpoints included access-site and systemic complications. Duplex ultrasonography and Barbeau testing were performed two weeks post-procedure.
Results: All 45 procedures (100%) were successfully completed without conversion to another access site. The mean sheath insertion time was 153.3 ± 79.8 s, total procedural duration 30.8 ± 14.9 min, and hemostasis time 87.1 ± 14.2 min. Minor complications included puncture-site pain (15.6%), numbness (8.9%), minor bleeding (11.1%), and small hematoma (11.1%), all resolving conservatively. Duplex ultrasound at follow-up showed preserved ulnar patency in 95.6% and antegrade flow in 88.9% of patients. No major bleeding, hand ischemia, neurological deficit, or major adverse cardiovascular or cerebrovascular events occurred.
Conclusion: The distal transulnar approach is a safe, feasible, and efficient alternative for coronary angiography and PCI, providing high procedural success, rapid hemostasis, and excellent vascular preservation with minimal complications.