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, p = 0.008). After 4:1 propensity score matching, second‐degree DVA remained more prevalent in TRA versus TUA (2.9% ( n = 648) vs. 0% ( n = 162, p < 0.001)). 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.