The Prevalence of Difficult Vascular Anatomy in Transulnar Versus Transradial Access for Cardiac Catheterization in Propensity Score-Matched Cohorts.

Background and Aims: Transradial access (TRA) is used with a Class IA recommendation for coronary angiography (CA) or percutaneous coronary intervention (PCI). Difficult vascular anatomy (DVA) of the forearm arteries is a challenge to its success. Transulnar artery access (TUA) may constitute a viable alternative. Methods: In this single-center study, we retrospectively compared the prevalence of DVA at the forearm arteries in 2565 consecutive cases of CA/PCI (2403 TRA and 162 TUA) between 2019 and 2022. DVA was classified as zeroth-degree if the forearm could be passed with a standard 0.035″ guidewire. First-degree was defined if a standard 0.035″ guidewire had to be switched to a hydrophilic 0.035″ or a 0.018″ guidewire to successfully reach the brachial artery and second-degree DVA if the forearm arteries could not be passed with any guidewire leading to procedural failure. Results: In the overall cohort, DVA was significantly more prevalent in TRA versus TUA (zeroth-degree, first-degree, second-degree: 90.3%, 7.2%, and 2.5% vs. 96.9%, 3.1%, and 0%, respectively, Discussion: In our retrospective analysis, primary TUA was found to be superior to TRA regarding DVA at the forearm arteries. TUA may present a superior alternative to TRA for CA/PCI in the era of ultrasound-guided arterial access.