Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: Systematic review and meta-analysis

Abstract

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 An extensive search was undertaken for published and unpublished trials up to May 2017.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 (RR 0.90; 95% CI 0.66–1.23). Complications associated with access including hematoma formation, pseudo-aneurysm, and arterio-venous fistulae formation, were investigated in five trials in a total of 2,744 patients, with significantly more complications noted in the trans-ulnar group (RR 3.58; CI 2.67–4.79, P < 0.00001). 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.

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2DPeFa1
via IFTTT