We report a case series of four patients with radial artery occlusion complicating vascular access who were scheduled for coronary angiography. We describe the challenges in selecting adequate vascular access in patients with a history of coronary angiography and percutaneous coronary intervention, as well as the benefits of using preprocedural ultrasound examination of forearm arteries to detect radial artery occlusion. Our case series suggests that if the anterior interosseous artery provides partial blood supply to the hand as a collateral circulation of the occluded radial artery, the transulnar approach may be an alternative safe option for coronary angiography and percutaneous coronary intervention in this population.
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