Distal Radial and Ulnar Arteries: the Alternative Forearm Access

  • Analkumar Parikh
  • Kelly Q. Jia
  • Sumeet K. Lall
  • Ravi S. Shah
  • Ian C. GilchristEmail author
Coronary Artery Disease (D Feldman and V Voudris, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Coronary Artery Disease


Purpose of review

Radial artery access for catheter-based procedures has demonstrated improved margins of safety and patient comfort without a loss of efficacy compared with femoral access. Unfortunately, radial access is not always available, so a review of the alternatives such as the ulnar artery and distal radial artery has been completed to understand alternative access sites that may preserve the benefits of distal forearm access without losing the efficacy of traditional transradial access.

Recent findings

Several different trials have demonstrated the utility of ulnar access as a possible workhorse access point. These suggest efficacy and safety, but inferior ease-of-access and more crossover than traditional radial access exists. Distal (dorsal) radial access has also been shown to have reasonable efficacy and offer some ergonomic advantages, but this comes at the price that 20–30% of all comers may not have a sufficiently large artery to use.


Understanding the anatomy and techniques required to access the non-traditional, distal forearm arteries increases the skill set of operators. While neither the ulnar nor distal radial appears to substitute completely for radial access, both have potential applications that should be considered, and their utility should not be ignored.


Complications Cardiac catheterization Vascular access Review Hemostasis 


Compliance with Ethical Standards

Conflict of Interest

Ian C. Gilchrist reports personal fees from Terumo Interventional Systems, Inc., personal fees from Cardinal Health, Inc., personal fees from Abiomed, Inc., outside the submitted work.

Analkumar Parikh declares that there is no conflict of interest. Kelly Q Jia declares that there is no conflict of interest. Sumeet K Lall declares that there is no conflict of interest. Ravi S Shah declares that there is no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


ICG has consulting interests with Terumo Interventional Systems and Cardinal Health without connection to this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Analkumar Parikh
    • 1
  • Kelly Q. Jia
    • 1
  • Sumeet K. Lall
    • 1
  • Ravi S. Shah
    • 1
  • Ian C. Gilchrist
    • 1
    Email author
  1. 1.College of Medicine, Penn State Heart & Vascular Institute, M.S. Hershey Medical CenterPennsylvania State UniversityHersheyUSA

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