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CardioVascular and Interventional Radiology

, Volume 30, Issue 3, pp 351–354 | Cite as

Access to the Superficial Femoral Artery in the Presence of a “Hostile Groin”: A Prospective Study

  • Adrian J. Marcus
  • Kevin Lotzof
  • Adam HowardEmail author
CLINICAL INVESTIGATIONS

Abstract

Purpose

Lower limb angioplasty is commonly performed via antegrade common femoral artery (CFA) puncture, followed by selective superficial femoral artery (SFA) catheterization. Arterial access can be complicated by a “hostile groin” (scarring, obesity, or previous failed CFA puncture). We prospectively investigated color duplex ultrasound (CDU)-guided SFA access for radiological interventions.

Methods

Antegrade CDU-guided CFA and SFA puncture were compared in 30 patients requiring intervention for severe leg ischemia who had hostile groins. Demographics, screen time, radiation dose, intervention, and complications were prospectively recorded.

Results

Treatment in 30 patients involved 44 angioplasties (40 transluminal, 4 subintimal) and 2 diagnostic angiograms. Fifteen of these patients had CDU-guided CFA punctures; in 8 of these patients CDU-guided CFA puncture “failed” (i.e., there was failure to pass a guidewire or catheter into the CFA or SFA), necessitating immediate direct CDU-guided SFA puncture. Overall, the mean screen time and radiation dosage, via direct CDU-guided SFA puncture in 30 patients, was 4.8 min and 464 Gy cm2 respectively. With CDU-guided CFA puncture, mean screen time (10 min), radiation dose (2023 Gy cm2), and complications (13%) were greater when compared with the SFA puncture results overall and in the same patients at subsequent similar procedures (2.7 min, 379 Gy cm2 (p < 0.05), no complications in this subgroup). Five complications occurred: 2 each at CFA and SFA entry sites, and 1 angioplasty embolus.

Conclusions

The CDU-guided SFA puncture technique was both more effective than CDU-guided CFA access in patients with scarred groins, obesity, or failed CFA punctures and safer, with reduced screen times, radiation doses, and complications.

Keywords

Angioplasty Antegrade arterial puncture Common femoral artery Complications Superficial femoral artery Ultrasound guidance 

References

  1. 1.
    Wolosker N, Nakano L, Duarte FH, et al. (2003) Peroneal artery approach for angioplasty of the superficial femoral artery: A case report. Vasc Endovasc Surg 37:129–133Google Scholar
  2. 2.
    Chitwood RW, Shepard AD, Shetty PC, et al. (1996) Surgical complications of transaxillary arteriography: A case control study. J Vasc Surg 23:844–850PubMedCrossRefGoogle Scholar
  3. 3.
    Baudouin CJ, Belli AM, Cumberland DC (1990) The complications of high brachial artery puncture. Clin Radiol 42:277–280PubMedCrossRefGoogle Scholar
  4. 4.
    Saltzman J, Probst P (1987) A new puncture needle (Seldinger technique) for easy antegrade catheterisation of superficial femoral artery. Eur J Radiol 7:54–55PubMedGoogle Scholar
  5. 5.
    Bohndorf K, Gunther RW (1991) A new catheter configuration for selective antegrade catheterization of the superficial femoral artery: Technical note. Cardiovasc Intervent Radiol 14:129–131PubMedCrossRefGoogle Scholar
  6. 6.
    Bishop AF, Berkman WA, Palagallo GL (1985) Antegrade selective catheterization of the superficial femoral artery using a movable-core guide wire. Radiology 157:548PubMedGoogle Scholar
  7. 7.
    Berman HL, Katz SG, Tihansky DP (1986) Guided direct antegrade puncture of superficial femoral artery. AJR Am J Roentgenol 147:632–634PubMedGoogle Scholar
  8. 8.
    Nice C, Timmons G, Bartholomew P, Uberoi R (2003) Retrograde vs. antegrade puncture for infra-inguinal angioplasty. Cardiovasc Intervent Radiol 26:370–374PubMedCrossRefGoogle Scholar
  9. 9.
    Stephens FO (1995) Induction (neo-adjuvant) chemotherapy: Systemic and arterial delivery techniques and their clinical applications. Aust N Z J Surg 65:695–707Google Scholar
  10. 10.
    Anon (2002) Guidance on the use of ultrasound locating devices for placement of central venous catheters. NICE Technology Appraisal Guidance, no. 49Google Scholar
  11. 11.
    Dravid VS, Zegal HG, Morales AV, et al. (1999) Iatrogenic femoral injuries: Relation to arterial entry site. Applied Radiology Online, AugGoogle Scholar
  12. 12.
    Kim D, Orron DE, Skillman JJ, et al. (1992) Role of superficial femoral artery puncture in the development of pseudoaneurysm and arteriovenous fistula complicating percutaneous transfemoral cardiac catheterization. Cathet Cardiovasc Diagn 25:91–97PubMedCrossRefGoogle Scholar
  13. 13.
    Blais C (1993) Antegrade puncture of the superficial femoral artery: A pilot project. Can Assoc Radiol J 44:253–256PubMedGoogle Scholar
  14. 14.
    Yeow KM, Toh CH, Wu CH, et al. (2002) Sonographically guided antegrade common femoral artery access. J Ultrasound Med 21:1413–1416PubMedGoogle Scholar
  15. 15.
    Lechner G, Jantsch H, Waneck R, et al. (1988) Relationship between the common femoral artery, the inguinal crease, and the inguinal ligament: A guide to accurate angiographic puncture. Cardiovasc Intervent Radiol 11:165–169PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  1. 1.Department of RadiologyBarnet General HospitalLondon
  2. 2.Department of Vascular SurgerySt. George’s HospitalLondon
  3. 3.LondonUK

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