Comparison of procedural efficiency between transradial and transfemoral access in iliac artery EVT: a retrospective study.

Abstract

Transradial access (TRA) is increasingly used in endovascular therapy (EVT) due to its favorable safety profile. However, its procedural efficiency compared to transfemoral access (TFA) remains under investigation. We retrospectively analyzed 132 consecutive EVT procedures for iliac artery lesions performed between April 2020 and March 2024. After excluding 11 dialysis-dependent and 3 urgent cases, 118 elective cases were included (TRA: 65; TFA: 53). Four procedural time intervals were assessed: (1) room entry to local anesthesia, (2) local anesthesia to sheath removal, (3) sheath removal to room exit, and (4) total room time. In the primary analysis, 45 matched pairs were created using propensity score matching based on five covariates: chronic total occlusion (CTO), bilateral calcification, TASC C/D lesions, stent occlusion, and covered stent use. A secondary analysis was performed in 19 matched CTO cases using three covariates. In the matched cohort, TRA demonstrated significantly shorter total room time compared to TFA (75 [60-115] vs. 105 [74-163] min, p = 0.003). Sheath removal to room exit time was also consistently shorter in the TRA group (7 [5-10] vs. 14 [12-17] min, p < 0.001). Similar findings were observed in the CTO-matched subgroup (93 [77-163] vs. 160 [110-220] min, p = 0.012). TRA significantly reduces procedural time compared to TFA in iliac artery EVT. The consistent reduction across all phases, including the post-procedural period, highlights TRA as an efficient and practical access strategy in peripheral vascular interventions.