Wrist Access for Peripheral Artery Surgery Proven Safe but Faces Higher Six Month Complication Rates

New CARPOOL study data compares wrist and groin access for PAD treatment, showing procedural safety but higher repeat surgery rates for radial entry.

By: AXL Media

Published: Apr 25, 2026, 9:02 AM EDT

Source: Information for this report was sourced from EurekAlert!

A Shift in Surgical Entry Points for Vascular Intervention

The medical community is currently evaluating a transition in how surgeons access the body to treat lower extremity peripheral artery disease. Findings from the CARPOOL study, the largest real world comparison of its kind, were unveiled at the SCAI 2026 Scientific Sessions in Montreal. Traditionally, interventional cardiologists have relied on the common femoral artery in the groin as the primary entry point for revascularization. However, the new data explores the efficacy of radial-to-peripheral access, which utilizes the radial artery in the wrist. While this wrist based approach is already the gold standard for coronary procedures, its application in treating leg blockages has remained a subject of clinical debate.

Analyzing Technical Success and Limb Safety Endpoints

The study utilized a propensity matched analysis of 546 patients from the multicenter XLPAD registry, covering data from 2003 through 2024. Researchers focused on a primary endpoint of major adverse limb events, which encompasses all cause mortality, major amputations, and target vessel revascularization. Technically, the groin based approach maintained a slightly higher procedural success rate of 95 percent compared to 87 percent for the wrist based method. Despite this gap, the radial approach was deemed clinically non-inferior within the researchers' prespecified margins, suggesting that the wrist is a viable and safe gateway for reaching lower extremity lesions.

Long Term Complications and the Revascularization Gap

While the initial surgery may be successful, the six month follow up data revealed a notable discrepancy in patient outcomes. The group that received the wrist based intervention experienced nearly double the rate of major adverse limb events at 15.8 percent, compared to 8.1 percent for those treated via the groin. This increase was almost entirely attributed to a higher necessity for target vessel revascularization, meaning patients required follow up procedures to reopen the same vessel. According to the data, mortality rates and major amputation risks remained nearly identical between the two groups, at 3.3 percent and 1.1 percent respectively.