Technical Approach to Antegrade Femoral Access

Wager, Jaime; Gandhi, Ripal; Powell, Alex

doi:10.1053/j.tvir.2015.04.005

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…However, 4F sheaths were also used, and although the distance of puncture from the femoral head was not reported, retrograde punctures and high CFA bifurcation cases were included, indicating that these were punctures close to the femoral head. In another prospective trial, Gutzeit, et al (17) investigated 100 US-guided direct antegrade SFA accesses, reporting a 15.7% complication rate, including 10.2% pseudoaneurysm formation, which is exceedingly higher than the reported 0.2% incidence of pseudoaneurysm formation during US-guided CFA punctures, as well as results herein presented (6,16,18). Still, hemostasis was again obtained mainly by manual compression (84 cases resulting in 9 pseudoaneurysms), while the Starclose SE® VCD was used in only 14 cases resulting in one pseudoaneurysm formation (17).…”

Section: Discussionmentioning

confidence: 38%

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Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

Spiliοpoulos

Kitrou²,

Christeas³

et al. 2016

Diagn Interv Radiol

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Section: Discussionmentioning

confidence: 38%

“…pared with the retrograde approach and has also been related with increased bleeding complication rates (6). Among the main reasons to avoid or fail to obtain ipsilateral antegrade access is the presence of a "hostile" abdomen, in obese patients (5).…”

mentioning

confidence: 99%

Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

Spiliοpoulos

Kitrou²,

Christeas³

et al. 2016

Diagn Interv Radiol

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“…6 This is a major issue associated with antegrade femoral puncture (AFP), which is the preferred strategy to treat lower limb obstructive disease, as it is the most direct and least time-consuming treatment method available for the condition. 7…”

Section: Introductionmentioning

confidence: 99%

Sheathless use of Supera stent minimizes access complications in antegrade femoral puncture: Technical note with case series

et al. 2021

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Antegrade femoral puncture (AFP) is the preferred strategy to treat lower limb obstructive disease. However, the presence of vascular calcification may be associated with procedure related adverse events, impairing endovascular device strategies. We describe a case series of superficial femoral and popliteal artery treatments by Supera stent implantation using a simple technique to significantly minimize the dimension of the antegrade femoral puncture from 6 to 4 French (Fr). All antegrade femoral punctures, crossing femoro-popliteal lesion and predilation were made with 4 Fr introducer. After preparation the Supera stent was navigated in sheathless fashion via 0.018-inch guidewire. Postdilation and final control were made replacing the 4 Fr introducer via the same guidewire. A good final result was achieved. Patients were discharged early without any complications. This minimally invasive technique in cases of infrainguinal peripheral artery disease could be feasible and effective for minimizing the risk of complications in patients with critical limb ischemia.

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“…Femoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Adequate training in safe arterial puncture (Fairley et al, 2016) and audit of outcomes are essential in minimising and recognising associated complications (Wagner et al, 2015; Rajebi & Rajebi, 2015). Complications predominantly relate to haemorrhage following arterial access.…”

Section: Introductionmentioning

confidence: 99%

Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre

et al. 2018

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BackgroundFemoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. From April 2010 to May 2013, data was collected prospectively for all femoral arterial access procedures performed in the Interventional Radiology department of a tertiary hospital. For vascular sheath size <6-Fr, haemostasis was achieved by manual compression. For 6-Fr sheath size, a closure device was used in the absence of any contraindication.ResultsOf the 320 femoral access cases with eligible inclusion criteria, 52.5% had 4-Fr whilst 47.5% had 6-Fr vascular sheaths inserted. Overall post procedure complications rates were significantly higher following 6-Fr sheath (17/152 (11.2%)) versus 4-Fr systems (3/168 (1.8%)) (p=0.0007) mostly comprising self-limiting hematoma. There was no significant difference in major complications that required escalation of treatment.ConclusionNo significant difference has been demonstrated between the use of either sheath systems for major complications. The practical limitations of a smaller system, combined with existing body of evidence, may not justify the routine use of 4-Fr sheath systems as the primary sheath size for all endovascular procedures.

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Technical Approach to Antegrade Femoral Access

Cited by 4 publications

References 13 publications

Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

Sheathless use of Supera stent minimizes access complications in antegrade femoral puncture: Technical note with case series

Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access – prospective audit at a single interventional radiology centre

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