Transradial Access for Peripheral Arterial Disease: Aortoiliac Applications

Classically, endovascular interventions for peripheral arterial disease (PAD) have been performed using a transfemoral arterial approach (TFA). However, there are many benefits to employing a transradial arterial approach (TRA) for PAD interventions. This chapter focuses on the role of TRA in treating aortoiliac disease. Given its shorter distance and fewer great vessels crossed, the left radial artery is preferred. The small size of the radial artery makes a 6 French sheath the maximum size recommended to limit the risk of radial artery occlusion or spasm. For aortoiliac disease, plain balloon angioplasty and bare metal stenting is available, but covered stents and aortic interventions with stent grafts are not feasible for most patients using TRA alone given the size of tools compatible with 6Fr platforms. Other limitations such as absence of re-entry devices and bail out stents are needed to improve the capabilities of TRA PAD interventions.