الفهرس 
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Abstract
Coronary angiography (CA) is the gold standard method for detection of arterial narrowing related to atherosclerotic coronary artery disease .This procedure provides the most reliable information for determining medical therapy effectiveness as well as interventional procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with CAD. (Golabchi et al., 2010)
Transulnar approach had been proposed for elective procedures in patients not suitable for transradial approach. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or weak radial pulse . (Li et al., 2010)
Our study is a prospective single center comparative study conducted at Cardiology Department Cath lab of Beni-suef University Hospital during the period between February 2018 and August 2019, aimed to assess feasibility and safety of transulnar approach in coronary angiography and angioplasty. The study included 120 patients coming for coronary angiography or coronary intervention at our Cath lab, they were distributed randomly for each vascular access , procedures were performed by our staff members, the patients were distributed as follows; 80 patients in the radial group and 40 patients in the ulnar group.
Inclusion criteria:
Patients aged >18 years who were admitted for coronary angiography with or without intervention.
Exclusion criteria:
1.Patients with cardiogenic shock or pulmonary edema.
2.Patients who have done or prepared for CABG using Radial grafts.
3-Chronic renal failure patients with arteriovenous fistula or those patients who have the potential of having arteriovenous fistula.
patients were subjected to full history taking, basic clinical examination, electrocardiogram (ECG) and echocardiography were done to all cases. Procedural success, procedural time and fluoroscopy time were recorded, All patients were examined carefully immediately after procedure and before discharge to assess any complications. Doppler evaluation to both radial and ulnar arteries a day after the procedure was done to all cases.
Results of the present study showed that the majority of the study population were male (80%); the mean age was about 57 years, smoking was the predominant risk factor followed by dyslipidemia then Hypertension and finally diabetes with no statistical significant difference between both groups.
The procedure success regarding ulnar approach was(82.5%) versus (93.7%) in radial group ,failure of ulnar artery puncture was the only cause of cross over in ulnar group (7) cases, while in radial group: occurance of persistent spasm was the leading cause of cross over in (4 ) cases followed by radial artery tortousity in (1) case .
Our study results showed that there was no statistically significant differences between both groups regarding all types of complications (P-value>0.05) : Three cases in ulnar group (7.5%) showed ulnar artery occlusion after the procedure documented with post procedure duplex compared to two cases in the radial group (2.5%) ,arterial spasm :( 4) cases in the radial group (5%) developed persistent spasm compared to (1) case of transient spasm in the ulnar group (2.5%) , Minor haematoma : occured in the same percentage in both groups (2.5%) .Our results also showed that , one incident of non-access site complications (Death during hospitalization) occured in radial group, The mean caliber of ulnar artery was (2.45 ± 0.38 )mm slightly larger than the radial artery: ( 2.33 ± 0.38) mm at the level of the wrist with no statistical significant difference.
Regarding the fluoroscopy time there was no statistically significant differences between both groups but, the procedure time of CA and PCI of the ulnar group was significantly higher than that of the radial group (P-value=0.011 and 0.034, respectively) The mean procedure time regarding ulnar group was (22.6 ± 2.6) min in CA and ( 36.1 ± 4.1) min in PCI compared to (21.2 ± 2.9) min in CA and (34.2 ± 4.8) min in PCI in radial group .
Our study demonstrated that ulnar access in our patients is a safe and practical approach for coronary angiography or angioplasty, without any major complication, it can be used when a radial artery is not useful for the catheterization and in cases such as prior harvesting of the radial artery (in prior CABG).