Zoltan Ruzsa presents results from a pilot study evaluating transradial access for femoral artery interventions. The study included 141 patients with symptomatic femoral artery stenosis treated via transradial access using 6F sheathless guiding catheters between 2014-2016. Angiographic and technical success rates were high at 87.2% and 75.9% respectively, with minor access site complications in only 3 patients (2.1%). While long term follow up showed revascularization was needed in 23.4% of patients at 12 months, the results demonstrate transradial access for femoral interventions can be performed safely with acceptable morbidity. Larger comparative studies are still needed to determine long term outcomes compared to traditional femoral access.

1. Zoltán Ruzsa MD PhD

2. Speaker's name: Zoltan Ruzsa
 I do not have any potential conflict of interest to report:
Potential conflicts of interest

3. Access site selection for lower limb interventions
0
50
100
150
200
250
300
350
1 2 3 4 5 6
Femoral
Radial
Brachial
Dual- Radial + Femoral
Dual- Radial + Transpedal
Dual- Femoral + Transpedal

4. Background
• Limited data exists in the literature about
transradial femoral interventions 1,2.
• The purpose of this pilot study was to evaluate
the acute success and complication rate of the
transradial access for femoral artery
intervention.
1. Lorenzoni R et al. J Endovasc Ther. 2014 Oct;21(5):635-40.
2. Lorenzioni R et al. EuroIntervention. 2011 Dec;7(8):924-9.
3. Hanna EB, Prout DL. J Endovasc Ther. 2016 Apr;23(2):321-9.

5. Routine access site selection-
femoral
- Multilevel disease
Iliac + Femoral + BTK
- Distal stenosis
- Non diseased
CFA
- Popliteal lesion
Anterograde
femoral
- SFA stenosis close
to the CFA
- Diseased CFA
Cross over
possible
Brachial or radial access
No cross over
-Scar
-Bypass
-Stents in the iliac ostium
-Extreme angulation
-Extreme tortuosity
Is there a place for primary radial
access for femoral artery intervention
???
Cross over
- Complex CTO
(failed antegrade)
Popliteal or
transpedal
yes
No
No No

6. Sheathless guiding
Coronary SG 8.5 F 100 cm
Internal D: 2.28 mm
External D: 2.8 mm
Peripheral SG 6F 120 cm
Internal D: 2.29 mm
External D: 2.8 mm

7. Methods
The clinical and angiographic data of 141 consecutive patients with symptomatic femoral artery
stenosis treated via transradial access using 6F sheathless guiding between 2014 and 2016.12 were
evaluated in a pilot study.
Inclusion criteria:
•Significant, isolated femoral artery stenosis or occlusion
•Intermittent claudication (Fontaine IIa-b)
•Critical limb ischemia (crural ulcer, pedal gangrene, ischemic rest pain)
Exclusion criteria:
•Contraindication of the transradial access (negative Allen test, radial artery occlusion)
•Contraindication of the 6 F usage in the radial artery: very small radial artery (<2 mm) and severe
calcification or stenosis
End points:
•Primary endpoint:
– major adverse events (MAE),
– rate of major and minor access site complications.
•Secondary endpoints:
– angiographic outcome of the femoral artery intervention,
– consumption of the angioplasty equipment
– X Ray dose, procedural time, cross over rate to another puncture site and hospitalisation in
days.

8. Methods: Angioplasty technique
• Medical therapy
- Transradial cocktail (NaHeparin
5000 U and 2.5 mg Verapamil)
- Per os Aspirin and Clopidogrel
- Heparin up to 100 U/kg
• Patient positioning
– Right radial: Normal
– Left radial: Inverse
• Punction and cannulation
- Local anesthaesia and dedicated
5F TR sheath
• Diagnostic angiography
- 125 cm Pig tail catheter

9. Crossing the aortic arch
Easy aortic
arch
Difficult
aortic arch

10. Methods: Angioplasty technique
Cannulation of the iliac artery
- 6 F 120 cm Asahi sheathless guiding over a long Starter or
Extra-support 0.035 GW (Jindo, Amplatz)
- 6.5 F 90 cm Asahi sheathless coronary guiding catheter over a
long Starter or Extra-support 0.035 GW
- Telescoping technique with a MP 125 cm 5F catheter
Angioplasty
-„Road map imaging”
- Balloon angioplasty with long inflations (2-3 min)
- Focal stenting (Optimed stent with 180 cm long shaft)
- Long 300 cm 0.18 or 400 cm 0.18 GW (Roadrunner, Cook)
- Alternative access site is the popliteal or transpedal access for
stenting----For DEB or DES and Stent with high radial force
(Supera)
- Femoral access site only in bail out cases
- Final angio
Postop treatment
- Non occlusive pressure bandage
- Immediate mobilisation

11. Femoral artery
CTO

12. Demographic and clinical data n (%)
Demographic data Age (years)
Male
Hypertension
Current smokers
Diabetes mellitus
- IDDM
- NIDDM
Weight (kg)
Height (cm)
Chronic obstuctive pulmonary disease
Renal insuffitiency
67.6 ± 9.8
89 (63.1)
136 (96.5)
22 (15.6)
74 (52.5)
25 (17.7)
49 (34.8)
79.4 ± 16.6
168.0 ± 8.2
8 (5.7)
31 (22)
Cardiac and vascular history CAD
Previous PTA
Previous bypass
Previous major amputation
PAD
- IC
- CLI
- ALI
47 (33.3)
52 (36.9)
15 (10.6)
0 (0.0)
57 (40.4)
82 (58.2)
2 (1.4)
Fontaine classification I
IIa
IIb
III
IV
0 (0)
11 (7.8)
45 (31.9)
34 (24.1)
51 (36.2)

13. Results- Angiographic data
Angiographic and procedural data n (%)
Quantitative measurements
Common femoral artery
Diameter stenosis (%)
Lesion length (mm)
Reference diameter (mm)
Superficial femoral artery
Diameter stenosis (%)
Lesion length (mm)
Reference diameter (mm)
Popliteal artery
Diameter stenosis (%)
Lesion length (mm)
Reference diameter (mm)
12.3 (29.3)
6.2 (19.7)
5.8 (0.8)
79.4 (27.6)
82.2 (67.2)
5.5 (0.6)
14.2 (33.4)
9.2 (28.6)
4.6 (0.5)
Angiographic and procedural data n (%)
Lesion type
Chronic total occlusion (%)
TASC A
TASC B
TASC C
TASC D
66 (46.8)
74 (52.5)
32 (22.7)
14 (9.9)
21 (14.9)
Angiographic result of the intervention
Successful
-Good result
-Satisfactory result
Unsuccessful
128 (87.2%)
11 (7.8%)
7 (5%)

14. Results- Procedure
Primary Access:
- Radial n=138 (97.9%)
- Ulnar n= 3 (2.1%)
Side:
- Right side n= 114 (80.8%)
- Left side n= 27 (19.2%)
Secondary Retrograde Access (DUAL):
- Popliteal and AFS n= 4 (2.8%)
- Pedal n= 14 (9.9%)
Cross over to Anterograde Femoral
- to femoral n=4 (2.8%)

15. Results- technique and devices
• POBA: 107 (75.9%)
• 5 pts retrograde IMPACT
• Stenting: 34 pts (24.1%)
• Anterograde 22 pts (64.7%)
• Retrograde 12 pts (35.9%)
• 10 Supera
• 2 Zilver PTX

16. Results – Impact of the side selection
Left hand access
(n= 27)
Right hand access
(n= 114)
Procedure time (min) 35.5 27.7-43.3 34.9 30.3-39.5
Fluroscopy time (sec) 806.7 554.8-1059 723.2 601.7-844.8
X Ray dose (Gy) 14.09 10.4-17.7 23.5 8.3-38.6 ★
Contrast consumption (ml) 107.6 84.5-130.6 114.3 101.2-127.4
Advantage of the left hand access:
- Easy access to the descendentic aorta
- Shorter delivery system is necessary

17. Long term follow up
• MAEs at 12 months: 33 pt (23.4%)
•TLR at 12 months: 10 pts (7.1%)
•Another PTA at 12 months: 17 (12.1%)
MAE (MACCE+ TLR + Amp) n (%)
- Death
- AMI
- Stroke
- Amputation
- rePTA
- MAE
- ALL MAE
10 (7.1)
1 (0.1)
2 (1.4)
10 (7.1)
10 (7.1)
37 (26.2)
33 (23.4)
MAE (n=33) n (%)
- IC
- ALI
- CLI
10 (30.3)
1 (3)
21 (63.6)

18. POC n (%)
Procedural complications
- Distal embolisation
- Edge dissection and additional stent
Renal failure
Summary
1 (0.7)
5 (3.5)
0 (0)
Access site complications
Minor
RAO
Compartment syndrome
Spasm
Perforation
Major
Summary
3 (2.1)
0 (0)
0 (0)
0 (0)
0 (0)
3 (2.1)
Perioperative complications

19. Limitations of the study
- The main limitation of the study is the
lack of femoral control group
- It is not a randomized study
• Technical limitation:
– We haven’t drug eluting balloons and stents
with long shaft length, therefore for these
cases the transpedal and transpopliteal
access must be prepared

20. Femoral artery intervention Optimal case

21. Access ??
- iliac stent
- diseases CFA
-Long SFA CTO
-Popliteal CTO
- ATA and ATP occl
TR access
-6F SG
-V18 GW 300
-Treasure12 300
-Invatec 5x150 180
-Invatec 6x150 180
-Optimed 6x80 180
Peroneal access
-Cook 4F
-Progress40 300
-Fox 4x80
Difficult case
-Multilevel
-Long CTOs

22. Patient with CCS 3 angina
and rest pain

24. Right SFA recanalisation
Right ulnar artery access
6F 120 cm SG
Starter GW
V18 GW
Pacific 180 cm 5x150 mm

26. Zilver PTX 6x120 mm

27. CASE – Pt with CLI and SFA occlusion

33. Conclusion
• Femoral artery angioplasty can be safely and
effectively performed using radial access and
sheathless guiding with acceptable morbidity and high
technical success.
• Although complication rates of the present pilot
register are promising, larger studies are needed to
determine the long term success rate of transradial
femoral PTA.

34. Thank you for your attention !!!