IP197. Transradial Treatment of Infrainguinal Peripheral Artery Disease

Abstract

Transradial access (TRA) has traditionally been favored for coronary interventions. Its use in the treatment of infrainguinal peripheral artery disease (PAD) has been constrained by the length of devices and the size of sheaths required. Recently introduced tools now allow operators to safely treat increasingly complex lesions transradially. The purpose of this study was to review safety and feasibility of using TRA for treatment of infrainguinal PAD. Patients with infrainguinal PAD who underwent intervention through TRA from September 2016 to December 2018 were reviewed. Exclusion criteria included sheath >6F, Barbeau D waveform, radial artery diameter <2 mm, and history of severe aortic tortuosity or radial artery occlusion. Tools to facilitate TRA for infrainguinal PAD included 6F 119-cm Destination Sheath (Terumo Interventional Systems, Somerset, NJ), 475-cm Viper guidewire (Cardiovascular Systems Inc, St Paul, Minn), 180-cm shaft length Pacific Plus balloon (Boston Scientific, Marlborough, Mass), 150-cm shaft length Everflex Entrust stent (Medtronic, Santa Rosa, Calif), and 200-cm working length Diamondback Atherectomy (Cardiovascular Systems Inc). Procedural details, technical success (adequate inline flow to foot without crossover to alternative access), clinical success (defined as improvement in ankle-brachial index, clinical symptoms, or wound healing), and major and minor adverse events (AEs) were recorded from follow-up visits. There were 23 procedures completed using TRA in 19 patients (median age, 67 years [range, 29-86 years]; 12 male, 7 female) with median height of 67 inches. One patient had both lower extremities treated during the same procedure. Preprocedure Rutherford classification (class 2/3/4/5/6) was 5/12/0/5/1, respectively. Technical success was 100%, and median fluoroscopy time was 18.4 minutes; 15 patients were discharged home the same day. Treated vessels included the superficial femoral artery (n = 20), popliteal artery (n = 9), tibioperoneal trunk (n = 2), tibial vessels (n = 4), and plantar vessels (n = 1). Five (22%) procedures treated TransAtlantic Inter-Society Consensus D lesions involving the superficial femoral artery. Interventions included angioplasty (n = 14 [61%]), atherectomy (n = 6 [26%]), and stenting (n = 14 [61%]). Median follow-up was 81.5 days (range, 6-501 days). AEs included a radial artery pseudoaneurysm treated with vessel coiling (major AE, n = 1), an access site hematoma/bleeding (minor AE, n = 4), and a small superficial femoral artery perforation (minor AE, n = 1) after stenting that was successfully treated with prolonged balloon tamponade. All noted AEs were clinically insignificant at 30 days, and there were no deaths. Clinical success was 94.7% with one clinical failure in a patient with Rutherford class 5 disease who had progressive wounds resulting in major amputation despite revascularization. Five patients underwent reintervention during follow-up because of recurrent stenosis. Although technically more challenging because of limited wire, catheter, and device selection, transradial treatment of infrainguinal PAD is feasible and safe in appropriately selected patients.