OBJECTIVES: To review indications, techniques, and equipment of transradial access (TRA) in peripheral interventions and to compare complications, main outcomes, and costs between TRA and transfemoral access (TFA) in patients undergoing lower extremity peripheral artery procedures.

METHODS: We systematically searched PubMed for studies published in English between 2008 and 2018 comparing TRA and TFA among patients undergoing endovascular peripheral artery interventions.

RESULTS: The data suggest that TRA may be a safe treatment approach in patients who are not suitable for TFA, including obese patients, patients with heavily calcified femoral arteries, or with history of femoral surgery. Endovascular peripheral interventions performed via TRA had high procedural success rates, low rates of access-site and bleeding complications, and simplified post-procedure care, but increased radiation exposure and longer procedure time compared to TFA. There is only one single center study that compared the costs of the two accesses. Peripheral angioplasty via TRA was associated with higher cost for devices compared with TFA with vascular closure device. However, based on the coronary studies where TRA is more frequently used, TRA could be cost-effective due to decreased bleeding complications and shorter hospital stays.

Adoption of TRA in the peripheral interventions is still limited. The main barrier to the adoption of TRA is the lack of dedicated equipment with adequate length and small enough outer diameter. Atherectomy devices, for example, are limited by both shaft length and outer diameter. The only atherectomy device that could be used from TRA is the peripheral orbital atherectomy system.

CONCLUSIONS: TRA can be used in situations where TFA is unsuitable. TRA leads to shorter post-procedural monitoring, earlier ambulation, reduced length of hospital stay and less discomfort compared to TFA. Comparative studies are needed to determine the cost-effectiveness of the radial approach for peripheral interventions, as demonstrated in the coronary procedures.