Radial arterial access demonstrates procedural safety for treatment of peripheral artery disease: Study

Results from the largest real-world propensity-matched comparison to date show that radial-to-peripheral (R2P) access achieves procedural success rates comparable to traditional common femoral artery (CFA) access for lower extremity peripheral artery disease (PAD) revascularization. However, six-month major adverse limb events (MALE) were higher in the R2P group, predominantly driven by target vessel revascularization (TVR). Researchers presented the late-breaking data today at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions & Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d’intervention (CAIC-ACCI) Summit in Montreal.

In 2021, the ACC/AHA/SCAI Coronary Artery Revascularization Guidelines designated radial artery access, a minimally invasive approach in which physicians perform procedures through the radial artery in the wrist, as a Class I, Level A recommendation for patients undergoing coronary percutaneous coronary intervention (PCI) to reduce bleeding and vascular complications, reflecting strong clinical evidence supporting the approach. Despite radial access becoming common for coronary procedures, most interventions for PAD are still performed through the common femoral artery in the groin. To date, clinical evidence supporting transradial access in peripheral arterial interventions has been largely limited to single-arm and observational studies.

In this retrospective study, researchers utilized data from the multicenter, core laboratory-adjudicated XLPAD registry (2003-2024, NCT01904851) to propensity match consecutive R2P procedures to CFA cases, adjusting for demographics, cardiovascular risk, and clinical presentation. The primary endpoint was MALE, a composite of all-cause mortality, TVR, and major amputations at six months. Among the 546 patients included in the study, nearly half of the lesions were chronic total occlusions, and mean lesion length was greater in the CFA group. In addition, the use of stents (56%) and drug-coated balloons (29%) was similar in both groups.

Using a multivariable Cox proportional hazards model, the study found procedural success was higher in the CFA group compared to the R2P group (95% vs. 87%, respectively) but remained clinically non-inferior (p=0.001; prespecified margin 15%). At six months, the R2P group had a higher incidence of MALE (15.8% vs. 8.1%; HR 1.99, 95% CI 1.19-3.35; p=0.006), mainly due to TVR (11.7% vs. 5.1%; p=0.006). Rates of death (3.3%) and major amputation (1.1%) were similar between the two groups.

“With proper training, experience, and the right equipment, many patients can be safely and effectively treated by a transradial approach to treat their PAD,” said Sameh Sayfo, MD, MBA, FSCAI, interventional cardiologist at Baylor Scott & White The Heart Hospital in Plano, Texas. “In addition to procedural safety, this approach shortens hospital stays and makes bleeding complications easier to manage. Continued research and device innovation will be important to advance the technique further. We hope these findings help inform future randomized trials and ultimately contribute to meaningful changes in clinical guidelines for peripheral arterial interventions.”

Researchers noted that extended follow-up analyses are ongoing, with additional substudies planned to further evaluate outcomes.