Feasibility and Safety of Routine Transpedal Arterial Access for Treatment of Peripheral Artery Disease

Tak W. Kwan, MD;  Sooraj Shah, MD;  Nicholas Amoroso, MD;  Ravi Diwan, MD;  Parth Makker, MD; Justin A. Ratcliffe, MD;  Moinakhtar Lala, MD;  Yili Huang, DO;  Aravinda Nanjundappa, MD; Ramesh Daggubati, MD;  Samir Pancholy, MD;  Tejas Patel, MD

Objective. To demonstrate the feasibility and safety of transpedal arterial access for lower-extremity angiography and intervention.

Background. Traditionally, the femoral artery is chosen for the initial access site in symptomatic peripheral artery disease (PAD), but this approach carries a substantial portion of the entire procedural complication risk.

Methods. 80 patients were prospectively evaluated for the treatment of PAD between May and July 2014. All patients underwent peripheral angiography, and intervention if necessary. A pedal artery was the initial access site for all patients. Under ultrasound guidance, one of the pedal arteries was visualized and accessed, and a 4 Fr Glidesheath was inserted. Retrograde orbital atherectomy and balloon angioplasty were performed with a 4 Fr sheath or upsizing to a 6 Fr Glidesheath Slender (Terumo) for stenting as needed. Clinical and ultrasound assessment of the pedal arteries were performed before the procedure and at 1-month follow-up.

Results. Diagnostic transpedal peripheral angiography was performed in all 80 patients. 43 out of 51 patients (84%) who required intervention were successful using a pedal artery as the sole access site. No immediate or delayed access-site complications were detected. Clinical follow-up was achieved in 77 patients (96%) and access artery patency was demonstrated by ultrasound at 1 month in 100% of patients. Conclusion. The routine use of a transpedal approach for the treatment of PAD may be feasible and safe. Pedal artery access may also avoid many of the complications associated with the traditional femoral approach, but further study is needed.

J INVASIVE CARDIOL 2015;27(7):327-330

Key words: intermittent claudication, transpedal access, peripheral vascular disease

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