Percutaneous interventions of the lower extremities have traditionally utilized transfemoral access as the approach of choice. More recently, transradial access has been demonstrated to be a viable alternate approach for such procedures. Transfemoral access, either ipsilateral (antegrade or retrograde) or contralateral (“up and over”), provides familiar ergonomics, proximity to the target segment, and larger vessel dimensions, as well as an abundance of equipment choices designed for such an approach. Beyond the obvious benefits of transradial approach vis-à-vis early ambulation, decreased bleeding/vascular access site complications, etc., there may be certain specific instances in which transradial approach may be preferable over transfemoral approach for lower extremity interventions. Commonly encountered scenarios include:
- inability to gain access via the femoral system due to weak or absent femoral pulses,
- severe calcification or obstructive femoral arterial disease,
- prior stenting at the access site,
- scar tissue as in the case of patients who have undergone prior surgical revascularization,
- morbid obesity, or
- conditions precluding prolonged bedrest post-procedure.