title: Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions: A Single-Center Experience.
abstract: To compare the procedure and safety outcomes of the transradial approach (TRA) with the femoral approach (FA) for treating aortoiliac and femoropopliteal stenoses and occlusions.
  
  
  
  A single-center retrospective study was conducted involving 188 patients (mean age 66.4±10.8 years; 116 men) with lower limb claudication or critical limb ischemia who underwent aortoiliac (131, 62.4%) or femoropopliteal (79, 37.6%) interventions on 210 lesions over a 3-year period. Operator discretion determined TRA suitability; exclusions included Raynaud's disease, upper limb occlusive disease, previous TRA difficulties, or planned hemodialysis. Lesion characteristics, clinical endpoints, and access site complications were compared.
  
  
  
  FA was used primarily in 123 patients and the TRA (12 left and 53 right radial arteries) in 65 procedures. Eleven (16.9%) TRAs failed vs 9 (7.3%) FAs (p=0.42). Crossover to FA was due to occlusive lesions requiring alternative equipment in 9 cases and to tortuosity of the aortic arch vessels in 2 patients. The 134 FA interventions (balloon angioplasty, stents) were retrograde (112, 83.6%) or antegrade (22, 16.4%). There were significantly more TASC C/D lesions in the FA group (p=0.02). Sheath sizes (5-F to 8-F) did not differ between groups, and no significant differences were found between FA vs TRA in terms of procedure time (50.0±28.9 vs 46.8±25.1 minutes, p=0.50) or length of stay (2.2±0.6 vs 2.1±0.3 days, p=0.24). While there were no strokes, access site complications occurred in 6.0% of the FA patients vs 3.7% of the TRA patients (p=0.12).
  
  
  
  The transradial approach for aortoiliac and femoropopliteal interventions is safe and efficacious compared with the transfemoral approach for a range of lesion subtypes. Nevertheless, there remains a need for improvements in peripheral device and catheter technology to decrease transradial failure rates.
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Andrew K
authors: AK
authors: Roy
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Phillipe
authors: P
authors: Garot
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Yves
authors: Y
authors: Louvard
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Antoinette
authors: A
authors: Neylon
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Marco
authors: M
authors: Spaziano
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Fadi J
authors: FJ
authors: Sawaya
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Leticia
authors: L
authors: Fernandez
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Yann
authors: Y
authors: Roux
authors: Hôpital Claude-Galien, Quincy Sous-Sénart, France.|Department of Interventional Radiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Raphael
authors: R
authors: Blanc
authors: Hôpital Claude-Galien, Quincy Sous-Sénart, France.|Department of Interventional Radiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Michel
authors: M
authors: Piotin
authors: Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Stephane
authors: S
authors: Champagne
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Oscar
authors: O
authors: Tavolaro
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.
authors: Hakim
authors: H
authors: Benamer
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Thomas
authors: T
authors: Hovasse
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Bernard
authors: B
authors: Chevalier
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Thierry
authors: T
authors: Lefèvre
authors: Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France t.unterseeh@angio-icps.com.|Hôpital Claude-Galien, Quincy Sous-Sénart, France.
authors: Thierry
authors: T
authors: Unterseeh
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D003251:Constriction, Pathologic / Q000601:surgery*; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: angioplasty; aortoiliac bifurcation; endovascular intervention; femoral artery access; iliac artery; occlusion; peripheral artery disease; popliteal artery; radial artery access; stenosis; stent; superficial femoral artery