Transfemoral access remains the primary method for peripheral revascularizations despite the availability of transradial access which has lower risks for complications and shorter discharge times. Historically, transradial access was not performed due to the unavailability of longer sheaths. Terumo designed two long-length sheaths, Glideasheath Slender and R2P Destination Slender, for peripheral procedures. This study aimed to evaluate the efficacy and safety of transradial access (MáLEI- Minimal Arterial Access Lower Extremity Intervention) compared to transfemoral access in patients with mild to severe peripheral arterial disease (PAD).
Material and Methods:
A retrospective, unmatched, cohort study was conducted on patients with lower extremity PAD, Rutherford Classification Category 2-6, who had at least one transradial, transfemoral, or translunar peripheral revascularization. The primary objective was to compare clinical success (final residual diameter stenosis < 30%) with radial access to femoral access. Secondary objectives were to assess procedure time, fluoroscopy time, time to discharge, and complications. For the primary analysis, success rates for each group were calculated as the proportions of procedures meeting the clinical success criteria.
Ninety patients with severe PAD (Rutherford Grade 3-6) underwent a transradial, transfemoral, or translunar peripheral revascularization. All procedures (n=90) resulted in clinical success. Vessels treated via transradial versus transfemoral were the common femoral artery (n=8; 2), anterior tibial artery (n=12; 8), superficial femoral artery (n=36; 16), peroneal artery (n=12; 5), common iliac artery (n=11; 3), popliteal artery (n=15; 10), posterior tibial artery (n=13; 3), and dorsalis artery (n= 2; 3). For transradial versus transfemoral, average procedure time was 85.2 vs. 84.5 min, average fluoroscopy time was 30.3 vs. 29.4 min, and median time to discharge was 6.6 vs. 11.6 hr. One transfemoral patient (3.7%) experienced an access site bleed (BARC Type 1) and no other complications were noted.
In patients with severe PAD, a transradial approach for peripheral revascularizations is a comparative alternative to transfemoral. Findings from this analysis demonstrate that utilizing transradial access has similar efficacy and safety for successful peripheral revascularizations compared to transfemoral access.