Radial/Ulnar angioplasty in selected patients undergoing elective angiography or PCI using complex forearm approach

Background: Angioplasty on the radial artery have been performed with good success rates in patients with critical hand ischemia. We sought to assess the feasibility and safety of radial angioplasty on complex radial access in patients undergoing coronary angiography. Methods/Material: A prospective series of procedures with complex radial/ulnar access to which radial-ulnar angioplasty (RU-A) was performed. We set goals of efficacy and safety that included the success rate of the procedure (need for ¨Crossover femoral¨) and the existence of radial pulse at one month. Results: 18 cases of RU-A out of 11,500 procedures from March 2010 to July 2016 (0.15%) were included. The majority of the patients were men with a variety of cardiovascular risk factors (age 71 ± 9; 94% Hypertensive, 56% Diabetic, 18% chronic kidney disease). The most common indication for radial/ulnar angioplasty was severe arteriosclerotic stenosis. Angioplasty was performed with different types of over the wire peripheral balloons (Mean diameter 4,3 ± 1 and mean length 42 ± 15 mm), in one case a stent implantation was needed. The success rate was 100% without vascular complications at 1-month clinical and vascular doppler follow-up. Conclusions: Radial/ulnar artery angioplasty is feasible and safe in selected patients undergoing elective angiography or percutaneous coronary intervention using complex forearm approach. - Highlights: • Transradial approach (TRA) in coronary angiography and percutaneous coronary intervention (PCI) has become a viable and attractive alternative for the femoral approach. • There are still complex cases where the radial/ulnar access is not possible due to severe atherosclerotic disease and a different access can not be performed neither due to different reasons like arteriovenus fistulas, severe atherosclerotic stenosis, amputated patients, etc. • Radial/ulnar artery angioplasty could be feasible and safe in selected patients to seal an iatrogenic dissection or facilitate catheterization/PCI when no other possible upper extremity access was available.