Evaluation of the Forearm Dominancy Artery for Invasive Vascular Procedure with 3D-CT Angiography

The aim of this study was to evaluate the vascular dominance in the forearm as a factor in determining the choice of invasive vascular procedures in arteries of the forearm, using 3D-computerized tomography (3D-CT) angiographies of 92 forearms. The diameters of the ulnar and radial arteries were measured just distal to the bifurcation of the brachial artery, at the midpoint between the bifurcation and the wrist, and at the wrist crease. In 79 cases, the ulnar artery was larger than the radial artery after the bifurcation of the brachial artery. However, no statistically significant difference was observed at either the mid-forearm or the wrist crease. In the remaining 13 cases, the diameter of the radial artery was larger or the same as that of the ulnar artery after the bifurcation, but at the more distal sites no regular pattern could be detected. The findings suggest that 3D-CT angiography offers valuable preoperative details of the forearm vessels for cases requiring invasive vascular procedures on the forearm.

Transulnar access for coronary angiography and intervention

To assess the safety and efficacy of a transulnar approach for coronary catheterization. Descriptive study. Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD], October 2009 to January 2010. Twenty five patients underwent coronary catheterization by the transulnar approach. Patients were selected for ulnar approach coronary angiography if they had a weak radial pulse with a stronger palpable ulnar pulse with a positive reverse Allen's test [< 10 sec]. No attempt was made at cannulating radial artery in the same sitting. A 6F sheath was placed inside the ulnar artery as per standard Seldinger technique, and cardiac catheterization or angioplasty was performed. The patients were examined before discharge from the hospital for any access site complications. Mean age of the patients was 48 years [range 30 to 62 years] and 80% [n= 20] were men and 20% [n=5] were females. Successful puncture was achieved in 100% [25/25]. One out of twenty five patients had same sitting PCI with stenting to LAD and LCX. No case of arterial spasm, haematoma, pseudoaneurysm, vascular perforation or loss of pulse was observed. We conclude that the transulnar approach is a safe and efficacious alternative for diagnostic and therapeutic coronary intervention in presence of weakly palpable radial artery and a stronger palpable ulnar artery with positive reverse Allen's test