Alternative access for peripheral vascular interventions

Andrea G Alonso; Anna Kobzeva-Herzog; Jeffrey J Siracuse

doi:10.1016/j.jvscit.2023.101232

Alternative access for peripheral vascular interventions

J Vasc Surg Cases Innov Tech. 2023 May 24;9(3):101232. doi: 10.1016/j.jvscit.2023.101232. eCollection 2023 Sep.

Authors

Andrea G Alonso¹, Anna Kobzeva-Herzog¹, Jeffrey J Siracuse¹

Affiliation

¹ Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.

Abstract

Percutaneous endovascular interventions for advanced lower extremity peripheral arterial disease are becoming increasingly used, often as first-line treatment of chronic limb threatening ischemia. Advancements in endovascular techniques have provided safe and effective alternative revascularization options, especially for high-risk surgical patients. Although the classic transfemoral approach results in high technical success and patency rates, an estimated 20% of lesions remain challenging to access via an antegrade approach. As such, alternative access sites are important in the endovascular armamentarium for the management of chronic limb threatening ischemia. The goal of this review is to discuss alternative access sites, specifically the transradial, transpopliteal, and transpedal approaches, in addition to transbrachial and transaxillary access, and their outcomes in peripheral arterial disease and limb salvage.

Keywords: Peripheral artery disease; Peripheral vascular intervention; Transpedal access; Transpopliteal access; Transradial access.