The first ever trans-ulnar angioplasty and stenting procedure in Asia Pacific and the US has been performed on three patients by doctors at Apollo Hospitals, Hyderabad on March 25. Dr PC Rath, director- Cardiac Cath Lab and Interventional Cardiology at Apollo has performed the operation on these patients.

Dr Rath performed Percutaneous Transluminal Coronoary Angioplasty (PTCA) and stenting for two vessels using the trans-ulnar approach in the patients including a 55 year old lady. The patients have recovered without any complications, Dr Rath said.

He explained that the procedure presents a safe, painless and viable alternative treatment of cardiac disorders. The ulnar artery located on the opposite side of the radial artery near the wrist is punctured and through this puncture the catheter and the stent is inserted in the tran-ulnar approach of angiogram, angioplasty and stenting.

The patient can walk back from catheterization to the bed and can be discharged the same day, a few hours after angiography and within 24 hours after angioplasty and stenting. However, as the artery is deep seated and close to a nerve, the procedure is to be done in selected cases by an experienced specialist, Dr Rath added

Ever since cardiologists started performing angiography and later angioplasty and stenting, the femoral (through the large arteries of the groin) was the most popular route for the puncture and introduction of different cardiac catheters.

Later on Trans-radial approach (where the radial artery at the wrist is punctured) has gained prominence as it is easily accessible, suitable for early mobilization and has less vascular complications at puncture site.

However, besides femoral and radial routes, a need for an alternative route was felt and thus emerged the trans-ulnar route. Dr Rath added, with increasing span of life, greater use of traditional routes and need for repeated procedures, the necessity to develop another route to approach the heart is felt and fulfilled by trans-ulnar approach.

It is significant to note that Dr Rath is the first cardiologist in the world to have performed a successful trans-ulnar coronary angiogram on a patient (Indian) in 1997. Apollo Hospitals is the second center in the world where PTCA and stenting has been performed through trans-ulnar route, the first being University of Pisa, Italy.