title: Transpedal approach for iliac artery stenting: A pilot study.
abstract: OBJECTIVE
  To demonstrate the safety and feasibility of the transpedal approach as an alternate arterial access site for iliac artery intervention.
  
  
  BACKGROUND
  The common femoral artery is the traditional access site for the endovascular treatment of iliac artery stenoses. However, this approach is associated with complication rates as high as 2%, including retroperitoneal bleeding which carries high patient morbidity and mortality. Furthermore, the standard femoral approach is associated with longer recovery times and longer time to ambulation which are important considerations especially when performing procedures in an ambulatory setting.
  
  
  METHODS
  Twelve patients were prospectively followed after treatment for symptomatic iliac artery stenosis via transpedal access. Under ultrasound guidance, one of the pedal arteries was visualized and accessed, and stenting of the iliac arteries were performed as per protocol. The patient was monitored immediately post procedure and clinical follow up was performed at one week and one month later.
  
  
  RESULTS
  The average age of the patients was 71years old. 58% were male. Most patients had Rutherford class III symptoms. Successful stent placement was achieved in all 12 patients via transpedal access. No conversion to femoral access was required. No complications immediately post procedure nor at any time period during follow up were noted. Lower extremity arterial duplex at one month showed patent stents and patent pedal access site vessels in all patients.
  
  
  CONCLUSIONS
  Transpedal arterial access may be a safe and feasible approach for iliac artery stenting. Given the possible benefits of avoiding femoral artery access, larger studies should be conducted directly comparing the different approaches.
authors.affiliation: Mount Sinai Beth Israel Hospital, New York, NY. Electronic address: jzachariah@chpnet.org.
authors.forename: Jips J
authors.initials: JJ
authors.lastname: Zachariah
authors.affiliation: Mount Sinai Beth Israel Hospital, New York, NY.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ratcliffe
authors.affiliation: Mount Sinai Beth Israel Hospital, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Ruisi
authors.affiliation: Mount Sinai Beth Israel Hospital, New York, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Puma
authors.affiliation: Quebec Heart and Lung Institute, Quebec, Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bertrand
authors.affiliation: Mount Sinai Beth Israel Hospital, New York, NY.
authors.forename: Tak
authors.initials: T
authors.lastname: Kwan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009519:New York City; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
keywords: Iliac artery stenting; Outpatient iliac artery stenting; Transpedal