Antegrade catheterization of the superficial femoral artery

On-Site-Modified Sheath to Overcome the Undesirable Catheterization of the Profunda Femoris Artery During Antegrade Femoral Access

Purpose: To present a simple method to avoid favored passage of a guidewire into the profunda femoris artery (PFA) after antegrade puncture of the common femoral artery. Technique: A 6-F conventional introducer sheath with a radiopaque distal marker is placed on the nurse's table with its side port orientated to the 12 o'clock position. A small (2-2.5 mm) oval fenestration is created on the superior aspect of the sheath about 3 cm from its tip with a size 11 surgical blade. The modified introducer is passed over the angled 0.035-inch guidewire into the PFA and gently retrieved until the tip marker is ~3 cm from the femoral bifurcation. The dilator is removed, and the guidewire is withdrawn to the level of the fenestration, manipulated through it, and advanced further into the superficial femoral artery under fluoroscopic guidance. Conclusion: When repeated passage of the guidewire down the PFA persists despite conventional manipulation of the wire or needle, an on-site modification of the sheath is an easy alternative approach for the catheterization of the superficial femoral artery.

A side-grooved guiding sheath as an effective treatment strategy for femoro-popliteal artery lesions

During revascularization for chronic total occlusion (CTO) of the proximal superficial femoral artery (SFA), the guiding sheath may prolapse out of the common femoral artery (CFA) or may not be fully inserted during treatment. Therefore, we have developed a treatment strategy using a novel side-grooved guiding sheath, whereby a 5.0-Fr guiding sheath (45 cm long) with a 1.0 mm × 5.0 mm rectangular side-groove is inserted into the deep femoral artery, the side-groove is aligned with the bifurcation, and the SFA lesion treatment is performed via the side-groove. This technique provides good stability and maintains the wire's torque performance, while avoiding sheath prolapse from its position in the CFA. We have successfully treated seven cases of SFA-CTO with this guiding sheath, and did not observe any increase in complications, procedure time, or amount of contrast media (vs. the conventional procedure). Therefore, our side-grooved guiding sheath appears to be safe and effective for treating SFA-CTO, and we hope to perform additional development of this technique.

Easy technique to overcome the undesirable catheterization of the profunda femoral artery during antegrade femoral access

BACKGROUND

We describe a simple method to avoid favored passage of the wire into the profunda femoral artery (PFA) after antegrade puncture of the common femoral artery.

METHODS

The method consists of placing a 3F Fogarty catheter into the origin of the PFA, which addresses the guidewire toward the superficial femoral artery.

CONCLUSION

When a repeated passage of the guidewire down the PFA is experienced despite conventional manipulation of the wire or needle, the barrier technique is an easy alternative approach for the catheterization of the superficial femoral artery.

Easy technique for retro-antegrade superficial femoral artery catheterization

The antegrade femoral approach is a routinely used technique for the percutaneous treatment of the lower extremities vascular disease. However, this approach can be challenging in case of obese patients or due to special anatomy of the femoral bifurcation. We present a simple and inexpensive alternative by means of the use of a Fogarty catheter to convert a retrograde femoral access to an antegrade catheterization.

Anatomical variants of the profunda femoris artery: an angiographic study

The bifurcation of the common femoral artery (CFA) into superficial and profunda femoris arteries (PFA) and the branching pattern of the PFA are subject to considerable normal anatomical variation. These variation patterns were assessed on normal lower limb angiograms of 94 adult patients. The main pattern (in 81% of patients) consisted of both medial and lateral circumflex arteries arising directly from a PFA situated lateral or posterolateral to the femoral artery. Previous studies of arterial variations in this region and the relevant embryology are reviewed. Relevance to angiographic procedures of the lower limb is discussed.

Antegrade selective catheterization of femoral vessels with a 4- or 5-F catheter and safety wire

A method of antegrade catheterization of the superficial femoral artery or femoral bypass grafts with a 4- or 5-F catheter and safety wire is described. This method has advantages of smaller size and the use of torque wires when compared with previously described methods.

A new catheter configuration for selective antegrade catheterization of the superficial femoral artery: technical note

A new 5 F catheter configuration is presented with a very short, 90 degrees angled tip that allows safe catheter tip rotation near the puncture site. This facilitates catheterization of the superficial femoral artery and permits easy conversion of a retrograde into an antegrade guidewire placement after puncture of the common femoral artery.

"Retroantegrade" catheterization of the branches of the femoral artery: technical note

Antegrade catheterization is the preferred approach to angioplasty and selective fibrinolysis of branches of the femoral artery. A simple method of antegrade catheterization beginning with a retrograde puncture and using a new catheter is described. The method can reduce the number of punctures and manipulations needed for selective antegrade catheterization of the common femoral artery.

The relationship between the common femoral artery, the inguinal crease, and the inguinal ligament: a guide to accurate angiographic puncture

The variability of the extraperitoneal puncture space between the inguinal ligament and the inguinal crease was evaluated in 100 patients. The distance between the inguinal crease and the inguinal ligament varied from 0 to 11 cm (average 6.7 cm +/- 1.9 SD), the average value for women (7.5 cm +/- 1.9 SD) being significantly greater than that for men (6.3 cm +/- 1.9 SD, p = 0.0128). The bifurcation of the common femoral artery was found below the inguinal crease in 20%, at the same level in 3.5%, and above it in 76.5% of cases. Consideration of these results will help avoid intraperitoneal puncture and improve the rate of successful antegrade puncture of the femoral artery.