PRILOZI, Odd. med. nauki, XXXIV 3, 2013 MANU CONTRIBUTIONS. Sec. Med. Sci., XXXIV 3, 2013 MASA ISSN 0351-3254 UDC: 616.137-007.272-089.844 TRANSRADIAL APPROACH AS FIRST CHOICE FOR STENTING OF CHRONIC TOTAL OCCLUSION OF ILIAC AND FEMORAL SUPERFICIAL ARTERY Slobodan Antov, Sasko Kedev University Clinic of Cardiology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, R. Macedonia Corresponding Author: Slobodan Antov, University Clinic of Cardiology, Vodnjaska 17, 1000 Skopje, R. Macedonia; Tel: + 389 (0)2 3 14 75 62; + 389 (0)2 070 20 69 09; E-mail: antovs@t-home.mk Abstract The transradial approach (TRA) for treatment of aortoiliac occlusive disease (AIOD) is nowdays a more common approach than several years ago. This is due to less post-procedural bleeding compli- cations and its impact on mortality. The main reason for the growing interest in the TRA is because of the safety profile of this access. Peripheral arterial disease (PAD) is a growing phenomenon. It is a common circulatory problem in which narrowed arteries reduce blood flow to lower extremities due to atherosclerotic arterial lesions. According to the Trans Atlantic Inter-Society Consensus on the Management of Peripheral Arterial Disease (TASC II), an endovascular approach is recommended in type A and B lesions, and an open surgical approach for type C and D lesions. The aim of the study is to put the accent on the advantages of the transradial approach (TRA) versus the transfemoral approach (TFA), its safety and efficacy in treating peripheral arterial disease (PAD) even in type C and D lesions, in well and properly selected patients on whom it may be performed, and to evaluate the outcomes of transradial iliac stenting (TRAIS), attempting to increase the demand for the new devices and tools for its treatment. These improvements will exclude some disadvantages and limitations of TRA in the field of endovascular peripheral interventions (distance from the puncture site to the lesion location, bigger support, thinner devices). Despite difficult lesions, TASC C/D, the overall primary procedural and technical success rate was 100%. The ankle brachial index (ABI) significantly improved from a mean of 0.46 to 0.90 and 0.94 on the six months follow-up. Angiographic estimated residual stenosis was 0%. No minor or major complications (haematoma, distal emboli, vessel dissection, rupture, death) were documented. The primary patency rate was 100% for the iliac and for the SFA. The secondary patency rate after 6 months follow-up was also 100%. Transradial access might be recommended as the first-choice vascular access site for interventions on the iliac, and even proximal femoral territories. This technique is still limited by the lack of adequate equipment. This issue should be overcome in the future. Key words: transradial approach, stenting, peripheral vascular disease, iliac artery occlusion, endovascular interventions. Introduction Dr. Lucien Campeau first reported the use of the radial artery for coronary angiography in 1989 [1]. Three years later, Dr. Ferdinand Kie- meneij adapted Campeau's technique for the first transradial coronary angioplasty [2, 3]. Since then, this approach has become more popular and has been extended to coronary interven- tions, particularly with the use of aggressive antithrombotic therapy. The main reason for the growing interest in TRA is because of the safety profile of this access.