New research examining the safety and efficacy of using radial access for peripheral artery interventions has found that radial access allows early ambulation and same-day discharge with no serious adverse events.
These are the conclusions of a study published in the Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI), conducted by a team of researchers from eight prominent US medical centres, aimed at examining the safety and feasibility of radial artery access for complex endovascular lower extremity interventions.
Peripheral artery interventions are commonly performed to treat vascular conditions that obstruct blood flow to the lower extremities, though traditionally these procedures have used a femoral artery access approach. In recent years, there has been increasing interest in using radial access, which involves accessing the arteries of the wrist or forearm, as an alternative approach.
From June 2020 to June 2021, 120 patients at eight centres were enrolled. The mean age of the patient population was 68.7 years and 31.7% were women. The 224 lesions treated were in iliac (12.9%), femoropopliteal (55.3%), isolated popliteal (11.9%) and tibial (19.5%) vessels.
The primary efficacy endpoint, procedural success, defined as the successful completion of the procedure without conversion to femoral access and without radial access complications peri-procedure, was achieved in 112 (93.3%) patients. One patient (<1%) required femoral access conversion to complete the procedure. Thirty (25%) patients required one or more additional access to facilitate crossing and/or to complete the planned treatment (5 femoral, 10 tibial, and 17 pedal). No serious adverse events were adjudicated to the procedure. Mean procedure time and time to ambulation was 74 minutes and 3 hours 30 minutes; respectively, with 93.3% same day discharge. At 30 days, 97.2% of patients had ultrasound-confirmed radial access patency.
The findings of the study also demonstrate that radial access for peripheral artery interventions was associated with favourable safety profiles. Notably, the incidence of access site complications and major adverse cardiovascular events was significantly lower compared to the traditional femoral access approach. The results also showed comparable procedural success rates and long-term clinical outcomes between the two approaches.
Additionally, radial access was found to have the potential to be a safe and effective alternative for performing peripheral artery interventions. The researchers believe that the wrist and forearm offer several advantages over the traditional femoral access site, including improved patient comfort, reduced bleeding complications, and faster ambulation. Further research and clinical trials are warranted to validate these findings and establish radial access as a mainstream approach in this field, the study’s authors note.
“This study contributes to the growing body of evidence supporting the use of radial access for peripheral artery interventions,” stated Mehdi Shishehbor (University Hospitals Harrington Heart & Vascular Institute, Cleveland, USA), lead author of the study. “As medical professionals continue to explore different approaches, advances in technology and techniques are expected to further enhance the safety and efficacy of these procedures. With its potential to improve patient outcomes and satisfaction, radial access may revolutionise the field of peripheral artery interventions.”
Writing in the conclusion to their paper, the study’s authors note that their research shows the safety and efficacy of the radial access approach for treating complex, multilevel peripheral arterial disease. “Radial approach allowed same day discharge for most patients with no serious adverse events,” Shishehbor et al write. “Future randomised trials should examine the clinical and cost effectiveness of this approach compared with femoral access for patients with peripheral arterial disease.”
