The use of radial access approaches for lower extremity peripheral artery disease, or "PAD", has been compelling but under-explored in radiology offices around the world.
What does 'Radial Access' mean?
Radial access alludes to procedures performed via the radial artery in the wrist as opposed to using the standard femoral route.
While techniques using the radial access approach have been part of the medical procedural playbook for decades, it has gained recent traction and viability in recent years.
Why would a radiologist consider the radial access approach?
There are a few benefits for deploying a radial access approach in treating peripheral artery disease:
Reduced risks and complications
Radial access approaches minimize access site complications.
Some patients experiencing obesity or coagulopathy will highly benefit from this approach because of its inherently reduced risk of hematoma or pseudoaneurysm.
Radial access means enhanced patient comfort
patients have reported that radial access procedures lead to far fewer sensations of discomfort than those who received groin access procedures.
This latter group is required to remain flat and still for hours on end–up to 2-6 hours minimum!
Radial access sites give radiologists more options
For patients with hostile anatomies (ie complex iliac arteries), it is radial access makes it easier to perform the procedure than accessing through the femoral artery.
Why hasn't there been more development in radial access procedures?
When asked about the slow adoption of this technique, Dr. Sabeen Dhand cited:
Dr. Dhand: There is nothing in particular about the anatomy that poses the challenge. Sometimes you might have tortuous central vasculature in the thoracic aorta, and you would lose pushability or torqueability, but you also lose wire feel, and wire feel is the most important for gentle revascularization of the iliac and infrainguinal arteries.
I believe the biggest issues from a technical standpoint are with the delivery sheath size, length, and compatibility. When treating proximal superficial femoral artery (SFA) disease, I want to have at least a 7- or 8-F bailout option if something could go wrong.
How does a radiologist determine radial access candidacy for PAD in patients?
Dr. Dhand again noted that hostile anatomies may present the best opportunity for radial access procedures for peripheral artery disease. Additionally, patients that are excessively obese or have heavily diseased common femoral arteries may also be good candidates.
These candidates would not typically be able to easily withstand femoral artery approaches, or they may be excessively difficult to navigate even by seasoned radiology experts.
Read the whole interview with Dr. Sabeen Dhand and Dr. Aaron Fischman in their September 2020 appearance of Endovascular Today.
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