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Sole transpedal access for infrainguinal endovascular intervention is a relatively new technique recently described by our group. Traditional femoral approach is still widely used despite associated significant complications. We describe a retrospective analysis with comparison of the two approaches in our practice.
We collected data of all infrainguinal endovascular intervention done by transpedal approach between May 2014 and December 2014 at our lab. To compare we collected data from a year prior (May 2013 to December 2013) when femoral approach was the norm at our practice. Transpedal group had 204 patients while the tranfemoral group had 199.
Patient characteristics and overall disease severity (TASC and Rutherford class) were similar between the two groups. The arterial access success rate was 94% in transpedal group vs 100% of femoral. Once the access was obtained, the procedural success rate was similar in both groups. Total of 3 patients required additional femoral access in the pedal group. No major complications were associated with transpedal approach and the access site patency was 100% at one month ultrasound follow up. In femoral group 13 large hematomas (6.5%) and one retroperitoneal bleed requiring transfusion was reported.
|Contrast Dose (ml)||44+11||68+13||<0.0001|
|Radiation dose (mGy)||25||48||<0.0001|
|Fluoro time (min)||5.48||9.35||<0.001|
Transpedal approach may be a safer alternative to traditional transfemoral approach with high success rate and reduced radiation dose, contrast use and complications. Patient comfort and shorter recovery time are other significant benefits of this approach. Long term follow up data on intervention site patency and clinical outcomes are not available in our analysis but we believe the choce of access site should not make a significant difference in those parameters.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention