Transpedal vs. femoral access for peripheral arterial interventions—A single center experience

Objective: To compare the transpedal approach to established femoral approach for endovascular treatment of infrainguinal peripheral arterial disease. Background: Endovascular treatment of infrainguinal peripheral arterial disease is on the rise. Femoral approach is widely used but has significant complications. Recently the primary transpedal approach has been described for endovascular interventions. We hypothesized that transpedal approach could reduce access site related complications. We compared the two approaches in a retrospective cross-sectional study at a single center. Methods: We analyzed demographics, procedural parameters, and complications in patients who underwent a primary transpedal approach for infrainguinal intervention and compared to patients with a traditional femoral approach in our outpatient based endovascular lab. Results: The success rate for access was lower in transpedal group compared to femoral (94% vs. 100%, p =.0002). The contrast dose (44 ± 11 mL vs. 68 ± 13 mL, p <.0001), radiation dose (25 mGy [16–43] vs. 48 mGy [36–67], p <.0001) and fluoroscopy time (5.48 min [3.48–11.71] vs. 9.35 min [6.63–14.11], p <.0001) were significantly lower in transpedal group. Conclusion: The transpedal approach for infrainguinal revascularization appears to be a reasonable primary approach with high success and low complication rate with significant reduction in radiation and contrast dose. These findings should be further studied in a randomized controlled trial.