Transradial approach to lower extremity interventions

Abstract

Percutaneous interventions of the coronary and peripheral vessels have historically been performed using a femoral artery approach. There has been increasing recognition of post-procedural bleeding complications and its impact on short- and long-term mortality. Because of its now recognized safety, the transradial approach has recently emerged as a preferred method compared to the transfemoral approach. The limitations associated with the distance from the puncture site to the lesion location are being addressed as new tools are developed for the endovascular treatment of peripheral arterial disease. In this review, we discuss the many facets of the transradial approach to lower extremity endovascular interventions, highlighting its safety and efficacy. Approaches to special populations including individuals with prior surgical bypass, Leriche's syndrome, and those committed to chronic anticoagulation are also reviewed.

Keywords: aorto-iliac angioplasty; endovascular interventions; peripheral arterial disease; transradial interventions.

Figure 1

Transradial approach to a left proximal SFA total occlusion in a patient with a history of aorto-bifemoral bypass. A) Distal anastamosis site of bypass conduit to CFA and total occlusion of SFA at its ostium. B) Crosser CTO recanalization catheter™ (Flowcardia) successfully passing through proximal total occlusion. C) Balloon angioplasty of proximal SFA. D) Final result at the end of procedure.

Figure 2

Transradial approach to Leriche’s syndrome. A) Aortogram showing distal aorta total occlusion. B) Balloon angioplasty of left common iliac artery (CIA) following successful wire crossing. C) Catheter-directed thrombolysis of left CIA. D) Left CIA opacification following overnight infusion of tPA. E) Kissing balloon inflation of bilateral CIA. F) Successful restoration of inflow.