Radial to Peripheral Intervention: A Paradigm Shift

The evolution of cardiovascular intervention has long been marked by the relentless pursuit of safety, efficacy, and patient comfort.Among the most transformative developments in recent years is the shift from traditional femoral approaches to transradial access (TRA), especially as this technique is now adapted for peripheral vascular interventions (PVI). 1 The emergence of radial access in percutaneous coronary interventions was, at first, met with skepticism; however, years of innovation, technical advancement, clinician persistence, and patient satisfaction have transformed radial access into the preferred route for percutaneous coronary interventions in many centers worldwide.The demonstrated reduction in bleeding and vascular complications, enhanced patient comfort, and faster postprocedure ambulation have been undeniable advantages. 2 Traditionally, interventions for the iliac, femoral, popliteal, and tibial arteries have relied on femoral or even brachial access.The TRA was preferred over transfemoral access for PVI in cases such as bilateral lower limb lesions treated in 1 procedure, iliac bifurcation stenting, bifurcated aortic grafts with planned pelvic or leg intervention, obesity, pelvic trauma, need for high-dose antithrombotic therapy or anticoagulation, and when the groin is unsuitable due to infection, skin breakdown, or high femoral artery bifurcation. 1 Nevertheless, the future of radial to peripheral (R2P) interventions is evolving swiftly and signals a paradigm shift.With an increasing number of physicians using radial access for coronary procedures and increasing equipment made specifically for R2P interventions, this shift is rapidly gaining momentum.In this issue of JSCAI, Khraisat et al 3 present their single-center experience with R2P interventions.The authors retrospectively reviewed 137 patients who underwent TRA for PVI between November 2021 and November 2024.The operators maintained a strong commitment to a "radial-first" approach.Unlike other similar studies, they primarily used left radial access. 4The left radial artery was used in 83.9%, the right in 7.2%, and the left ulnar in 8.7%.The authors provide a clear description of their procedural techniques and equipment choices for aortoiliac, infrainguinal, and infrapopliteal interventions.Notably, 36% of the interventions were for chronic total occlusions