Transfemoral coronary arteriography via a prosthetic aortic bifurcation graft

Angiographers may inappropriately avoid the transfemoral access route when a prosthetic aortic bifurcation graft exists. An aortofemoral graft will necessitate overdilatation of the femoral puncture site to allow adequate manipulation. If the puncture transverses both walls of the femoral limb of the graft into the native artery, further withdrawal of the catheter will allow reentry into the graft. When an aorta-to-external-iliac, end-to-side graft is present, transfemoral catheterization will frequently result in the guide wire or catheter tip terminating in the occluded common iliac artery. By choosing the proper catheter, entrance into the distal limb of the proximally communicating graft may be achieved. For the unwary operator, these confusing situations may result in failure to properly catheterize the graft. The methods of successfully overcoming these problems are discussed and illustrated.