Radial To Peripheral: The Efficacy of Transradial Access for Peripheral Interventions in Patients With Complex Transfemoral Access

Abstract

Introduction: The safety and feasibility of distal transradial access (TRA) is well-established for coronary interventions and has been increasingly used for peripheral angiography and intervention, especially with the increasing innovation and development of longer sheaths, balloons, and stent delivery systems. In the COVID-19 era, the emphasis on same-day discharge has led our institution to approach complex and challenging transfemoral cases through a transradial approach with favorable results. Methods: This is a retrospective review of cases deemed as complex femoral access due to the presence of complete total occlusion (CTOs), limited by patient body habitus or patients with prior endovascular aortic repairs (EVARs), and, thus, necessitated a TRA approach. Details of the patient characteristics and procedure were collected and evaluated. Results: Fifty-four patients underwent ultrasound-guided radial access. The average age was 67 ± 10 years, with 43 patients presenting with critical limb ischemia (Rutherford class 4). The mean height was 173 ± 9 cm and the mean body mass index was 30 ± 4.9 kg/m2. All patients underwent angiography through a transradial approach: 37% of patients had undergone intervention, with the majority of target vessels being iliac and/or femoral arteries;19% of patients were known EVARs with occluded graft limbs, and 22% had occluded surgical grafts. All patients received balloon angioplasty, 55% received mechanical aspiration thrombectomy or atherectomy, and 15% received stenting. The average procedure time was 88 ± 43 minutes with average contrast used of 179 ± 80 ml. The majority of patients were discharged the same day with an outpatient follow-up at one week. Conclusion: Our experience has emphasized the utility, efficacy, and safety in approaching peripheral interventions through distal radial access in obese patients with difficult, unfavorable transfemoral access, allowing same-day discharge and an economically feasible result.