Background
Recent studies have shown that antegrade access for treatment of infrainguinal peripheral
vascular disease is associated with decreased radiation exposure and contrast use
without a significant increase in access complication, although data are limited on
antegrade superficial femoral artery (SFA) access for larger sheath sizes. We aim
to describe a single institution's contemporary experience with percutaneous antegrade
SFA access.
Methods
A retrospective review of percutaneous, infrainguinal endovascular interventions for
arterial occlusive disease at a major academic institution was conducted between 2018
and 2020. Antegrade, percutaneous, SFA access cases were included. Information on
demographics, indication, sheath size, arteries treated, type of intervention, concurrent
pedal access, closure devices, and complications was collected and analyzed.
Results
A total of 45 patients with an average body mass index of 25.25 were identified. Indications
for intervention included tissue loss (64.4%), rest pain (6.7%), claudication (13.3%),
and acute limb ischemia (11.1%). Of which, 80.0% of patients had multilevel interventions.
Angioplasty was performed in 68.8% of patients, stenting in 8.3%, atherectomy in 15.6%,
and thrombectomy in 7.3%. Nearly a quarter of cases involved concurrent pedal access.
Maximum sheath size was 4F for 4.4% of patients, 5F for 28.9%, 6F for 46.7%, 7F for
11.1%, and 8F for 8.9%. The closure device was utilized in 75.6% of cases, with no
closure device failures. In the entire cohort, there were no demonstrated access site
complications.
Conclusions
This study demonstrates percutaneous, antegrade SFA access for complex endovascular
interventions for infrainguinal occlusive disease can be effectively utilized, even
with larger sheath size. Moreover, routine use of closure devices is safe, improving
patient comfort and expediting time to ambulation.
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Article info
Publication history
Published online: December 05, 2022
Accepted:
November 2,
2022
Received:
July 7,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
