Antegrade access in a stented common femoral artery: Feasible but with a real bleeding risk

Endovascular Treatment of Common Femoral Artery Disease

“…Therefore, if stenting is needed, a self-expanding stent as short as possible (e.g., 20 to 30 mm) should be chosen to allow the placement of the femoral bypass anastomosis or the CFA puncture-under fluoroscopic guidance-just above or below the implanted stent. Finally, in rare cases when no other vascular access is available, direct puncture through the CFA stent may be carefully performed (10).…”

Mastering the antegrade femoral artery access in patients with symptomatic lower limb ischemia: Learning curve, complications, and technical tips and tricks

“…However, our main goal was to appraise the learning curve of an in‐training operator, and thus increasing the sample size would have not offered benefit in such sense. Nonetheless, it is well known that antegrade access is fraught by an increased risk of local complications, including severe flow‐limiting or occlusive dissection, arterial perforation, [22] retroperitoneal hematoma, [23] and even peritonitis [24]. Thus, caution should be exercised in extrapolating the present results to other context and settings.…”

Commentary: Using Vascular Closure Devices Outside the Operating Room:No Reason for Homesickness!

“…This is also supported by the safe use of such devices in patently off-label indications, such as brachial, carotid, popliteal, or stented femoral arteries. 6,7 Yet, it is common sense to deploy a vascular closure device in the protected and well equipped setting of the angiosuite or operating room (OR), after carefully checking vessel anatomy and the needle entry point.…”

“…As the Table clearly shows, we conversely do not recommend using vascular closure devices outside the OR in cases of antegrade femoral access 11 ; puncture of the femoral bifurcation or the axillary, brachial, carotid, popliteal, 12 or superficial femoral arteries; or in a diseased or previously stented femoral artery. 7 Finally, enterprising interventionists should consider that an alternative to using vascular closure devices for carotid, iliac, renal, and superficial femoral artery procedures is to aggressively attempt radial/ulnar access whenever possible, given its established safety and comfort for patients and caregivers alike. 13…”