Advances in treating peripheral artery disease are variegated in nature–different radiologists and practitioners prefer different approaches to access, techniques and more when treating PAD.

Endovascular Today, a popular medical publication that covers advances in endovascular techniques, cases and technology, very recently invited our very own Dr. Sabeen Dhand to share his thoughts on a female patient with advanced dry gangrene of her left third and fourth digits.

Vascular case considerations

This case examines the patient's lower extremity peripheral artery disease, and asks a group of vascular specialists:

• What would be your initial imaging modality of choice?
• How would you approach revascularization?
• Where would you access?
• Do you need any additional information prior to this?
• When performing angiography via the radial artery what tools/medications do you routinely use?
• How would you treat the patient?

Vascular case considerations

• Female patient in her mid-60
• Dry gangrene on her left third and fourth digits
• Chronic obstructive pulmonary disease
• Hypertension
• Diabetes
• Hyperlipidemia
• Morbidly obese
• Myocardial infarction 6 months prior (taking aspirin and clopidogrel)
• History of kissing iliac stents placed for a prior right foot wound a decade ago (healed)
• Weak femoral pulses, but palpable
• Left nonpalpable popliteal and pedal pulses
• Left ankle-brachial index (ABI) = 0.6
• Toe pressure = 33 mm Hg

The case highlights the challenges faced by vascular surgeons and interventional radiologists as it applies to access. Radial access to treat peripheral artery disease can be a good option for the right patient–especially when there are limitations to standard femoral access like past open and/or endovascular surgery, and body habitus.

Radial access allows for an alternative location that allows for the treatment of multiple vascular beds, ease of closure and postoperative care. 

To get Dr. Dhand's full analysis and recommendation, please head over to the Endovascular Today - August 2022 issue to read the case in its entirety.

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