Transradial versus Transpedal versus Dual

Transradial – Transpedal Access Approach

for Endovascular Intervention of

Superficial Femoral Artery Chronic Total

OcclusionApurva Patel,MD; Wah Wah Htun,MD; Roosha Parikh, MD; Joseph A.

Puma, DO; Robert Bellavics, MD; John T. Coppola, MD; Olivier F. Bertrand,

MD, PhD; Zoltan Ruzsa, MD; Tak W. Kwan, MD

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Wah Wah Htun and co-authors

FINANCIAL DISCLOSURES:

None

UNLABELED/UNAPPROVED USES

DISCLOSURE:

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Surgical Bypass Endovascular Femoral

40-50% with PAD SFA-CTO

Introduction

Radial Pedal• Improved equipment

and techniques

• Early discharge

• Improved patient

comfort

• Reduce vascular

complications

• No comparison data

Introduction

Study Design-Methods

• Retrospective Study

• Endovascular intervention of SFA CTO for

symptomatic PAD

• Primary radial (TR) or primary pedal (TP)

or dual radial-pedal (TR-TP) approach

(Operator’s discretion)

• Two institutions (New York, USA and

Budapest, Hungary)

• January 2014 to January 2017

• As-treated analysis

Radial vs Pedal vs Dual Radial–Pedal – SFA CTO

• Outcomes

- Crossing success rate

- Procedural success rate

• Primary endpoint

- 30 day major adverse event (death, TVR,

amputation)

• Secondary endpoint

- Access site complication/patency at 30 days

Outcomes

Baseline CharacteristicsTR

(46 patients)

TP

(115 patients)P-value

Age (years) 67.8 ± 10.1 77.0 ± 9.0 0.001

Male, % 60.0 (21) 58.3 (49) 1.00

H/o Hypertension, % 91.4 (32) 88.1 (74) 0.75

H/o Hyperlipidemia, % 85.7 (30) 72.6 (61) 0.16

H/o Tobacco use, % 34.3 (12) 65.5 (55) 0.002

H/o Coronary artery disease, % 51.4 (18) 60.7 (51) 0.41

H/o Cerebrovascular accident, % 5.7 (2) 2.4 (2) 0.58

H/o Diabetes mellitus, % 51.4 (18) 57.1 (48) 0.68

Rutherford classification, % 0.02

III - VI 94 (43) 100 (115)

Results

LesionTR

(47 lesions)

TP

(137 lesions)

Dual TR-TP

(72 lesions)P-value

SFA TASC II classification, % <0.001

Class A 38.0 7.0 12.0

Class B 23.0 18.0 17.0

Class C 17.0 35.0 31.0

Class D 22.0 40.0 40.0

Results

TRA

(38 lesions)

TPA

(74 lesions)

Dual TR-TP

(72 lesions)P-value

Procedural Details

(As treated)

Contrast, mL 114.8 ± 66.8 46.1 ± 9.9 71.3 ± 57.8 <0.01

Fluoroscopy time, sec 715.2 ± 618.2 807.8 ± 516.3 2180.4 ± 1105.0 <0.01

Radiation dose10.2 ± 7.1

(Gy/cm2)

78.0 ± 89.4

(mGy)

271.2 ± 234.8 (mGy)

35.8 ± 15.0 (Gy/cm2)*

Results

TRA TPA Dual TR-TP P-value

Primary endpoint 0.08

MAE – 30 days, % 5.0 (2) 0 2.0 (1)

Death, n 1 0 1

Amputation, % 1 0 0

TVR, % 0 0 0

Secondary endpoint

Access site complications at

30 days, %0 0 0

Access site patency at 30

days, %100 100 100

Results

Transpedal Transradial

Dual

Transradial-Transpedal

Figure: Crossing and Procedural Success

Rates for Transpedal versus Transradial

Approach for Treatment of Superficial

Femoral Artery (SFA) Chronic Total

Occlusion (CTO),

Results

Limitations

• Two centers

- Generalizability

• Learning curve

• SFA-CTO intervention is feasible and safe using TR, TP,

dual TR-TP

- Early ambulation

- Early discharge

- Patient satisfaction/Improved QOL

- Reduction in vascular complications

• First data report

• Motivation for industry New device/equipments

• #RadialFirst for coronaries #RadialPedalFirst for SFA

Conclusion

Thank you#RadialFirst

@kwancardio

@patelapurva