Technical Approach to Antegrade Femoral Access

The number of endovascular procedures for treatment of peripheral arterial disease continues to increase as minimally invasive procedures have become the first-approach solution for lower extremity arterial lesions of any complexity, including Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) II category C and D. Although the usual treatment strategy has been to access the contralateral common femoral artery (CFA), an ipsilateral, antegrade CFA approach has certain advantages. The greatest advantages are the decrease in the access-to-lesion distance, which in turn improves the mechanical advantage and responsiveness of the tools used to perform the intervention. In certain clinical situations such as prior endovascular aneurysm repair, aortobifemoral surgical bypass, iliac kissing stents, and aortoiliac occlusive disease, an antegrade approach may be mandatory. In this article, we describe our institutional thought process and techniques for performing a successful antegrade puncture of the CFA, as well as highlight some pitfalls and the associated complication rates of which to be aware.