Contemporary Use of Radial to Peripheral Access for Management of Peripheral Artery Disease

Abstract

Compared with femoral access, transradial access for percutaneous vascular intervention has demonstrated several advantages, including lower risks of access site complications, faster patient recovery time, and lower health care costs. This has led to a growing interest in utilization of transradial access as the primary access site for certain peripheral vascular interventions (PVIs). This review outlines the rationale for transradial access for PVI, offers tips on equipment selection and special procedure-specific considerations, discusses challenges and barriers to widespread utilization, and highlights the latest developments in the field. Recent development of longer balloon and stent shafts and guiding catheters have made transradial access feasible for a larger number of PVIs, including internal carotid, vertebral, subclavian, and innominate; renal, celiac, and mesenteric; and aorto-iliac and superficial femoral artery disease. Despite these advances, there remain limitations with transradial access for PVI mainly due to the small size of the radial arteries and the distance from the radial arteries to the target vessels. In addition to new devices, there has been the development of newer approaches to limit radiation exposure, prevent radial artery spasm, and avoid radial artery occlusion. The benefits of radial access for vascular interventions have been well established. With ongoing innovation and studies demonstrating effectiveness and safety of this approach, “radial first” for peripheral interventions has a bright future and may someday become the standard of care for certain peripheral interventions.