title: Transradial approach as first choice for stenting of chronic total occlusion of iliac and femoral superficial artery.
abstract: The transradial approach (TRA) for treatment of aortoiliac occlusive disease (AIOD) is nowdays a more common approach than several years ago. This is due to less post-procedural bleeding complications and its impact on mortality. The main reason for the growing interest in the TRA is because of the safety profile of this access. Peripheral arterial disease (PAD) is a growing phenomenon. It is a common circulatory problem in which narrowed arteries reduce blood flow to lower extremities due to atherosclerotic arterial lesions. According to the Trans Atlantic Inter-Society Consensus on the Management of Peripheral Arterial Disease (TASC II), an endovascular approach is recommended in type A and B lesions, and an open surgical approach for type C and D lesions. The aim of the study is to put the accent on the advantages of the transradial approach (TRA) versus the transfemoral approach (TFA), its safety and efficacy in treating peripheral arterial disease (PAD) even in type C and D lesions, in well and properly selected patients on whom it may be performed, and to evaluate the outcomes of transradial iliac stenting (TRAIS), attempting to increase the demand for the new devices and tools for its treatment. These improvements will exclude some disadvantages and limitations of TRA in the field of endovascular peripheral interventions (distance from the puncture site to the lesion location, bigger support, thinner devices). Despite difficult lesions, TASC C/D, the overall primary procedural and technical success rate was 100%. The ankle brachial index (ABI) significantly improved from a mean of 0.46 to 0.90 and 0.94 on the six months follow-up. Angiographic estimated residual stenosis was 0%. No minor or major complications (haematoma, distal emboli, vessel dissection, rupture, death) were documented. The primary patency rate was 100% for the iliac and for the SFA. The secondary patency rate after 6 months follow-up was also 100%. Transradial access might be recommended as the first-choice vascular access site for interventions on the iliac, and even proximal femoral territories. This technique is still limited by the lack of adequate equipment. This issue should be overcome in the future.
authors.affiliation: University Clinic of Cardiology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Antov
authors.affiliation: University Clinic of Cardiology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia.
authors.forename: Sasko
authors.initials: S
authors.lastname: Kedev
mesh_terms: D000368:Aged; D000792:Angiography; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency