Percutaneous Trans-Superficial Palmar Artery Approach (Distal Ulnar) for Coronary Angiography and Angioplasty: A Preliminary Experience from Two Egyptian Cardiology Centers

Abstract Background Transradial access (TRA) has become the preferred route for coronary angiography (CAG) and percutaneous coronary intervention (PCI) due to its favorable safety profile compared to transfemoral access. However, TRA is limited by radial artery occlusion (RAO), anatomical variations, and spasm. The distal ulnar (superficial palmar) approach has recently emerged as a potential alternative with theoretical advantages, yet limited data exist regarding its clinical feasibility and safety. Aim and objectives This study aims to evaluate the feasibility, safety, and clinical performance of the percutaneous trans-superficial palmar artery (distal ulnar) approach for CAG and PCI, in comparison with the standard transradial approach. Methods This prospective, randomized clinical study included 90 patients undergoing CAG or PCI at two Egyptian cardiology centers. Participants were equally randomized to either the distal ulnar (n=45) or radial (n=45) access group. Procedural parameters (sheath insertion time, total procedure time, compression time, and hospital stay), access-related complications, and arterial patency were assessed. A follow-up was conducted at two weeks. Result Baseline demographics and CV risk profiles were comparable between the two groups. The distal ulnar group showed a significantly longer sheath insertion time (153.3 ± 79.8 vs. 68 ± 36.2 seconds; P<0.001), but a significantly shorter compression time (87.1 ± 14.2 vs. 133.6 ± 17.6 minutes; P<0.001) and hospital stay (107.8 ± 14.0 vs. 146.7 ± 31.1 minutes; P<0.001). No significant differences were observed in total procedure time (P=0.096), antegrade flow (P=1.00), or duplex-confirmed arterial patency (P=1.00). The incidence of complications—including pain, numbness, bleeding, hematoma, artery occlusion, or vascular injury—did not differ significantly between groups. Conclusion The distal ulnar approach is a safe, feasible, and effective alternative to the radial approach for CAG and PCI, offering shorter compression time and hospital stay despite a longer sheath insertion time.