[Conversion of a retrograde access to an antegrade access for bilateral femorocrural intervention in one session]

Evaluation of the feasibility as well as the success and complication rates of a change of access direction in patients with PAOD for bilateral intervention.

Over the course of one year, 239 patients referred to our department for intervention of the iliac and femorocrural vessels were evaluated for an ipsilateral change of access direction. In 38 patients (16%), the symptoms indicated a bilateral femorocrural intervention. Three patients (8%) had to be excluded due to elevated creatinine level. In the remaining 35 patients, an attempt was made to change the cross-over access to an antegrade access in the same session. The procedure was accomplished by drawing a sidewinder catheter in the ipsilateral CIA, pushing a hydrophilic guide wire into the SFA and repositioning the sheath. Sonographic and clinical controls followed the next day.

In 32 patients (91%), the procedure was successful, and in 3 cases (9%), it failed. One major hematoma (3%), which could be treated conservatively, occurred. In 2 cases (6%) pseudoaneurysms developed and were treated by compression or thrombin injection. 3 minor hematomas (9%) were documented. In one patient (3%) a stroke occurred during the intervention after a brain stem infarction some weeks before, which could not be related to the intervention (total rate of minor complications 9%, major complications 12%).

The bilateral intervention of femorocrural vessels in one session by changing the access direction ipsilaterally is feasible and associated with acceptable complication rates. It offers the opportunity to optimize endovascular therapy economically.