Balloon compression or haemostatic patch after distal foot arterial access for lower limb angioplasty: the PED-PRESS trial

Traditionally, lower-limb endovascular interventions have used transfemoral or transbrachial access. Alternative approaches such as transradial and distal foot artery (DFA) access are now, however, increasingly adopted12. DFA access (distal anterior tibial/dorsalis pedis, distal posterior tibial, and distal peroneal/perforator arteries) offers a smaller-calibre, superficial, and easily compressible artery, lowering access site bleeding complications2. Given the DFA’s small size, intravascular closure devices cannot be used; haemostasis relies on external compression. The standard method is manual compression, but dedicated devices are often employed for convenience. Two devices are commonly used: a balloon compression device (TR Band [Terumo]) originally designed for radial artery haemostasis3, and a topical haemostatic patch (StatSeal [Biolife]). StatSeal utilises a hydrophilic polymer that dehydrates blood and absorbs exudate, while its potassium ferrate-induced low pH aggregates proteins and promotes seal formation. StatSeal has demonstrated efficacy in reducing transradial access haemostasis time4. The PED-PRESS trial presented herein compared DFA access site complications utilising these two closure devices.

This prospective, randomised trial enrolled 150 patients. The procedures used ultrasound-guided DFA access. Patients were randomised to TR Band or StatSeal...