**8. Peripheral interventions via radial approach**

Peripheral interventions have adopted radial access to lower bleeding or due to hostile femoral artery anatomy [29]. Peripheral interventions include aorta, visceral, iliac/femoral and, rarely, popliteal [29, 30]. The learning curve for radial approach for peripheral interventions [29] may account for an increase in radiation [31]. Distance from the wrist to the site of percutaneous intervention is a limitation. Longer sheaths such as destination sheath by Terumo (**Figure 5a)** have allowed improved positioning for equipment. As with the sheathless guide, careful attention should be placed on pulling back the dilator before entering the aorta. Longer catheters have been developed by Terumo under the radial to peripheral program, (R2P) with shafts upto 200 cm including both balloons and self expanding peripheral stents (**Figure 5b).** Other companies have 170 cm catheter lengths including: Ultraverse RX (Bard); the Advance 14LP low Profile balloon (Cook); and the Armada 14 (Abbott), Mini Ghost (B.Braun), Steriling SL Monorail (Boston Scientific), Sleep OTW (Cordis) and Amphirion Deep OTW (Medtronic) all with catheters upto 150 cm in length. The longer shafts have furthered the use of radial access, along with left arm support and sheath extension but limited length of catheters with covered stents or drug coated balloons for infrainguinal disease [32].

**Figure 5.** *Long sheath R2PTM DESTINATION SLENDERTM Guiding Sheath b. 200 cm Long shaft R2PTM METACROSS® RX PTA Balloon Dilatation Catheter - ©2020 Terumo Medical Corporation. All rights reserved.*
