Transradial Access for Peripheral Arterial Disease: Infrainguinal 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 infrainguinal peripheral arterial disease. In order to perform lower extremity interventions from the radial artery, special consideration must be given to both the distance from the radial artery and vessel diameters. 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. Above the knee lesions are amenable to atherectomy, plain balloon angioplasty, as well as bare metal stenting using TRA. Unlike interventions from a femoral approach, most patients are not able to receive balloons or stents with drug eluting technologies. Below the knee intervention from the wrist is currently limited to angioplasty and atherectomy. Other limitations such as absence of re-entry devices and bail-out stents are needed to improve the capabilities of TRA PAD interventions.