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Transradial access may grow in endovascular treatment of critical limb ischemia

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CHICAGO — Transradial access in endovascular procedures for treatment of critical limb ischemia is feasible, and its use may grow when the technology advances, according to a presentation at AMP: The Amputation Prevention Symposium.

“Radial access will only continue to grow in the endovascular space,” said Constantino S. Peña, MD, from the Miami Cardiac & Vascular Institute at Baptist Health South Florida. “Economic, quality and patient pressures will aid in shifting toward radial interventions in the future.”

Transradial access has caught on in coronary-artery procedures because of low rates of access-site bleeding, the ability of patients to walk almost immediately after their procedure, faster room setup and turnover, and increased patient preference, Peña said.

“The radial approach significantly reduces mortality, MACE, bleeding and vascular complications and length of hospital stay,” he said. “It does not significantly affect door-to-balloon time, it is cost-effective, it is especially beneficial in STEMI and it offers more patient comfort.”

Current peripheral procedures employing transradial access include renal and mesenteric stenting and coiling, hepatic and splenic embolization, iliac angioplasty and stenting, and uterine fibroid embolization, Peña said.

It is possible for radial, ulnar and brachial access to be used to treat critical limb ischemia (CLI) in the lower extremities, but devices with longer shafts, longer balloons, and appropriate sheaths and guide catheters must be developed, he said. “Its role in CLI is limited by the lack of long and supportive technology.”

Potential risks include stroke as a result of crossing the great vessels, occlusion of the vessel and, most commonly in brachial-access procedures, compartment syndrome, according to Peña.

However, he said, there have been successful cases of transradial access in patients requiring endovascular revascularization in a lower extremity, and there will be more. – by Erik Swain

Reference:

Peña CS. Access modalities for CLI: You must have options. Presented at: AMP: The Amputation Prevention Symposium; Aug. 10-13, 2016; Chicago.

Disclosure: Peña reports financial ties with Boston Scientific, BTG, Cook Medical, C.R. Bard, Medtronic and Penumbra.