Retrograde vs. Antegrade Puncture for Infra-Inguinal Angioplasty

Abstract

This study was done to compare antegrade punctures with a retrograde puncture technique for infrainguinal angioplasty. A group of 100 consecutive patients (71 men, 29 women) were randomized for antegrade puncture or retrograde puncture of the common femoral artery. Following retrograde puncture the guidewire was 'turned' and placed into the superficial femoral artery. The time for gaining access, screening time, radiation dose, patient height, weight and complications were recorded. All patients were reviewed the day after the procedure and within 3 months. Data from 46 patients (34 males and 12 females) in the retrograde group and 44 (28 males and 16 females) in the antegrade group were available for analysis. Mean procedure time, screening time, radiation dose, height and weight were 8.3 minutes (range 3-22), 2.1 minutes (0.3-6.5), 7950 mGy cm(-2) (820-71250), 169 cm (149-204) and 79 kg (32-108) for retrograde puncture and 8 min (2-60), 0.7 min (0.0-3.2), 1069 mGy cm(-2) (0-15400), 169 cm (152-186) and 75 kg (39-125) for antegrade punctures, respectively. An average of 1.2 (1-2) punctures was required for retrograde and 1.75 (1-8) for antegrade. Seven small hematomas occurred with antegrade and three for retrograde puncture. Retrograde puncture is technically easier with a tendency to fewer complications but results in a higher radiation dose. This technique should be used in difficult patients at high risk of haematoma formation.

Ultrasound-guided antegrade femoral access: comparison between the common femoral artery and the superficial femoral artery

“…For SFA access ultrasound guidance is necessary. The direct antegrade puncture of the superficial femoral artery has already been described in small studies [6][7][8]. In these studies, it was assumed that antegrade access via the SFA could be an alternative access approach, for example, in special situations like "hostile groin", when puncture of the CFA is impossible [8].…”

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

“…Access sites for CLI include the ipsilateral antegrade femoral approach and the contralateral retrograde approach [2]. While the antegrade access may offer advantages such as better visualization and superior support, it has been associated with bleeding risk, especially in atherosclerotic femoral arteries.…”

“…Antegrade femoral access may offer advantages in this setting, but may lead to local hemorrhagic vascular complications, especially in atherosclerotic arteries [2]. To date, there is uncertainty on antegrade femoral approach in previously stented femoral arteries.…”

Below the Knee Techniques: Now and Then

“…Contralateral puncture is technically easier to achieve and safer in regard to local complications (Nice et al, 2003). It permits performing a strategic arteriography and the correction of proximal iliac and femoral lesions.…”