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Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: Systematic review and meta‐analysis
Author(s) -
Fernandez Ritin,
Zaky Fady,
Ekmejian Avedis,
Curtis Elizabeth,
Lee Astin
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27479
Subject(s) - medicine , radial artery , mace , cardiac catheterization , ulnar artery , percutaneous coronary intervention , percutaneous , hematoma , randomized controlled trial , meta analysis , surgery , cardiology , artery , myocardial infarction
Background Trans‐radial access has rapidly become the standard for percutaneous coronary procedures in the last decade. As proceduralists overcome the learning curve and become more competent in trans‐radial access, alternative safe access sites such as the ulnar artery have been increasingly used for emergent and elective procedures. The aim of this study was to synthesize the best available evidence of the impact on major adverse cardiac events (MACE) of ulnar artery compared to radial artery cardiac catheterization. Methods This review considered randomized controlled trials that included adult patients who had a percutaneous coronary procedure via the radial or ulnar artery. The intervention of interest was the use of ulnar compared to radial artery for cardiac catheterization. An extensive search was undertaken for published and unpublished trials up to May 2017. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument (JBI‐MAStARI) checklist. Data were analyzed using Review Manager. Results A total of six trials were included in the review. There was no statistically significant difference in the incidence of MACE between patients who underwent trans‐ulnar or trans‐radial artery catheterization (OR 0.90; 95% CI 0.65–1.25). Complications associated with access including hematoma formation, ( n = 6 trials) pseudo‐aneurysm, and arterio‐venous fistulae formation ( n = 5 trials), were investigated in a total of 5,276 patients, with no difference in these complications noted between the two groups. There were no differences in arterial access time, fluoroscopy time, and contrast load between the two groups. Conclusions There is evidence to support safe use of the ulnar artery as an alternative to the radial artery for access for cardiac catheterization.