Background Transradial approach, which is now widely used in coronary angiography and intervention may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach.

Objective The objective of this study was to evaluate the safety and efficacy of the transulnar approach vs the transradial approach for coronary angiography and intervention.

Methods 240 patients undergoing coronary angiography, followed or not by intervention, were randomised to transulnar (TUA) or transradial approach (TRA). Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalisation and 30 day follow-up. MACE as secondary end point was recorded till 30 day follow-up.

Results Successful puncture was achieved in 98.3% (118/120) of patients in the TUA group, and in 100% (120/120) of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 day after procedures was 11% vs 12.3% and 5.1% vs 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs 1.7% of patients 1 day and 30 day after transulnar angioplasty, and in 6.6% vs 4.9% of patients 1 day and 30 day after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively (p=0.949). No big forearm haematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 day follow-up was observed in all patients.

Conclusion The transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-calibre or thin radial pulse.