Background: The transulnar method of coronary angiography has emerged as an alternative to conventional transradial and transfemoral access, particularly in patients with difficult vascular anatomy or radial artery occlusions. Key benefits include preserving the radial artery for future procedures and potentially reducing access-site bleeding. However, concerns remain regarding its complication profile, including vascular spasm, hematoma, arterial occlusion, and nerve damage.

Objective: To establish the occurrence and nature of complications related to the transulnar approach among patients undergoing coronary angiography.

Methods: A descriptive, cross-sectional study was conducted at the Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) between August 2024 and May 2025. A sample of 120 patients undergoing coronary angiography via the transulnar approach was enrolled using non-probability consecutive sampling. All procedures were performed by certified interventional cardiologists. Complications such as hematoma, arterial spasm, occlusion, pseudoaneurysm, arteriovenous fistula, and sensory deficits were evaluated immediately after the procedure and at a 24-hour follow-up. Statistical analysis was performed using SPSS version 26.0.

Results: Out of 120 patients, 110 (91.7%) successfully completed the procedure via the transulnar approach, while 10 (8.3%) required crossover to transradial or transfemoral routes. Minor complications occurred in 22 (18.3%) patients, most commonly localized hematoma in 10 (8.3%), arterial spasm in 6 (5.0%), and transient sensory numbness in 4 (3.3%). Major complications like arterial occlusion were noted in 2 (1.7%) patients. No cases of pseudoaneurysm or arteriovenous fistula occurred. The majority of complications were managed without surgical intervention.Conclusion: The transulnar method for coronary angiography was found to be a safe and feasible alternative to the transradial approach, with a low rate of major complications. Minor problems like hematoma and spasm were fairly frequent but mostly mild and self-limiting. It serves as a viable option when performed by experienced operators in selected patients, particularly when the radial artery is unavailable.

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