Catheter-Directed Thrombolysis with Ulnar Artery Access in Acute Upper Limb Ischemia: A Rare Approach

Abstract

Acute upper limb ischemia (AULI) is less common than lower limb ischemia, and catheter-directed thrombolysis (CDT) is one of the treatment options. Approaches have been described for CDT, with ulnar artery access as an uncommon one. We present a patient with distal/digital AULI who underwent CDT using an uncommon ulnar artery approach, resulting in an excellent outcome. A 45-year-old male presented with continuous pain and numbness in the third and fourth digits of the left hand for 3 days, bluish discoloration, and coldness in those fingers. He had uncontrolled hypertension, diabetes mellitus, and was an active smoker. The distal radial and ulnar artery pulses were adequate, but oxygen saturation was not detectable over the affected digits. Doppler examination showed monophasic flow at the proximal phalanges of the third and fourth digits of the left hand. The patient was diagnosed with distal/digital AULI. Arteriography showed total occlusion of the mid-distal segments of the third to fourth digital arteries. CDT was performed with an antegrade proximal ulnar artery approach using a 25-mg alteplase infusion delivered through a 1.8F microcatheter that was placed in the superficial palmar arch. After the procedure, the discoloration resolved without complications. Arteriography evaluation showed improvement in digital artery blood flow. CDT with the ulnar artery approach is a feasible treatment option for distal/digital AULI. It is simple and safe with fewer complications. Further research is recommended to compare the risks and benefits of the ulnar artery approach with femoral and/or brachial approaches in CDT for distal/digital AULI.

Keywords

upper limb ischemia - catheter-directed thrombolysis - ulnar artery approach - vascular access - upper extremity - thrombolysis

Publication History

Received: 28 August 2025

Accepted: 12 January 2026

Article published online:
16 February 2026

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