Transradial Access Versus Transfemoral Access in Angioplasty and Stenting for Peripheral Arterial Diseases: A Meta-Analysis of Comparative Studies and Systematic Review.

PURPOSE: To compare the efficacy and safety of transradial (TR) versus transfemoral (TF) access in peripheral arterial angioplasty and stenting, providing evidence to guide clinical decision-making in endovascular interventions.

METHODS

A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) and cohort studies comparing TR and TF approaches in patients with peripheral artery disease (PAD) were included. Databases (PubMed, Embase, and Cochrane Library) were searched up to May 10, 2025. Risk of bias was assessed using the Cochrane tool, and RevMan 5.3 was used for statistical analysis. Outcomes included technical success, fluoroscopy time, hospital stay, minor/major bleeding, and access site complications.

RESULTS

Seventeen studies (13 210 patients) were analyzed. No significant difference was found in technical success (odds ratio [OR] = 1.48, P = .36, 95% CI, 0.64, 3.54). However, TR access was associated with a shorter hospital stay (mean difference = -0.09 days, P = .01, 95% CI, -0.16, -0.02) and a trend toward fewer access site complications (OR = 0.49, P = .07, 95% CI, 0.23, 1.06), with significant reduction in lower extremity interventions (P < .01). Transradial also showed lower bleeding risks, with a trend in minor bleeding (P = .09) and significant reduction in major bleeding (P = .03).

CONCLUSION

Transradial access for peripheral angioplasty and stenting offers advantages over TF, including reduced hospital stay, fewer complications, and lower bleeding risks. As TR techniques advance, TR may become the preferred approach, particularly when TF access is not feasible.Clinical ImpactThis study provides clinically relevant evidence supporting transradial (TR) access as a practical alternative to transfemoral (TF) access for peripheral arterial interventions. TR access showed fewer access-site complications, shorter hospitalization, and a trend toward reduced bleeding, suggesting benefits for both patient recovery and healthcare resource use. Although TF access remains preferable in certain femoropopliteal interventions, the growing availability of TR-specific devices and robotic technologies may further expand the role of TR access. These findings can guide access-site selection and improve procedural safety in clinical practice.