Percutaneous radial access for peripheral transluminal angioplasty

Abstract

The radial approach is currently gaining popularity in the setting of coronary percutaneous transluminal angioplasty (PTA) because it decreases the incidence of vascular complications. This study reports our initial results with radial access for peripheral PTA. Between November 2011 and January 2014, we performed peripheral PTA in 526 patients. PTA was performed through left radial access in 24 ambulatory patients (4.6%) presenting with TransAtlantic Inter-Society Consensus A or B lesions on preoperative computed tomography angiography. Materials included a 110-cm-long introducer, a 0.018-inch 400-cm-long wire, 150-cm-long angiography catheters, 180-cm-long shaft balloons and stents. Data were prospectively collected. There were 22 men (92%), median age was 65 years (range, 45-88 years), and 38 target lesions were treated. Indication for revascularization was disabling claudication in 22 patients (92%) and critical ischemia in two (8%). Indication for choosing the radial approach was bilateral hostile groins in 12 patients (50%), bilateral infrainguinal lesions in 4 (17%), need for a contralateral femoral approach in the setting of kissing iliac stents or bifurcated surgical aortic grafts in 3 (13%), and elective in 5 (21%). Radial puncture failed in one patient (4%), and PTA was performed through brachial access. Technical success was 91% (20 of 22 patients). Thirty-seven stents were implanted. Total procedure duration was 45 minutes (range, 30-120 minutes). Fluoroscopy time was 9 minutes (range, 5-35 minutes), and 40 mL (range, 20-90 mL) of contrast was necessary. Radial artery rupture secondary to spasm was noted at the end of the procedure in two patients (8%). All patients could ambulate 2 hours after the procedure. No patient died. Median follow-up was 8 months (range, 1-23 months). Three radial arteries (13%) were occluded at the last follow-up. At 6 months, freedom from target lesion revascularization and target vessel revascularization were 91% and 91%, respectively, for iliac lesions and 93% and 86%, respectively, for infrainguinal lesions. This study demonstrates the feasibility of radial access for peripheral PTA. Radial access could represent an alternative to brachial access for peripheral and visceral interventions. Although complication rates of the present series are concerning, larger studies are needed to determine the role of transradial PTA once the learning curve is overcome. A wider diffusion of the technique mandates (1) smaller-diameter sheaths, (2) longer shaft devices, and (3) the development of specifically designed rescue devices such as covered stents and thromboaspiration catheters.