Efficacy and Safety of MáLEI (Minimal Arterial Access Lower Extremity Intervention) on Multivessel Disease

Purpose: Patients with peripheral arterial disease (PAD) often present with multiple or bilateral lesions. Historically, transradial access could only be used for above-the-knee interventions because of the length of the devices, but a unique long-length peripheral sheath was produced to provide the ability to perform multivessel or bilateral revascularizations in one procedure via transradial access. This study aimed to evaluate the efficacy and safety of transradial access (minimal arterial access lower extremity intervention [MáLEI]) compared with transfemoral access in multivessel disease.

Materials and Methods: A retrospective, unmatched cohort study was conducted on patients with PAD who had at least one transradial or transfemoral peripheral revascularization. A post-hoc analysis stratified by the number of vessels revascularized during one procedure was conducted to compare procedure time, fluoroscopy time, and time to discharge with transradial access to transfemoral access.

Results: Procedures in 90 patients with PAD who underwent a transradial or transfemoral peripheral revascularization resulted in clinical success. Multivessel revascularization was more prevalent with transradial access with one (n = 21), two (n = 22), three (n = 15), four (n = 4), and five (n = 1) vessels revascularized during one procedure versus one (n = 27), 2 (n = 11), three 3 (n = 6) vessels with transfemoral access. For transradial, the total fluoroscopy time for one, two, three, four, and five revascularizations were 21.9, 30.9, 30.7, 64.6, and 55.2 minutes, respectively, and for transfemoral the times were 17.8, 27.0, and 53.1 minutes for one, two, and three revascularizations, respectively. The average procedure time was 84.5 minutes for transradial access sites compared with 85.2 for transfemoral access sites for all procedures. One transfemoral patient experienced an access site bleed (BARC type 1); no other complications were noted.

Conclusions: Regardless of the number of vessels revascularized during a single procedure, a transradial approach for peripheral revascularizations is a comparative alternative to transfemoral. Findings from this analysis demonstrate that as the number of vessels treated in one procedure exceeds two, the transradial approach provides shorter procedure times and less radiation exposure than the transfemoral approach.