Iliac Artery Dissection and Perforation During Crossover Sheath Insertion
Fundamentally, vascular access is arguably one of the most important steps in any interventional procedure. Determination of initial access site is based upon several factors, including the territory being treated, the complexity of the stenosis, anticipated complications, and distance to the target lesion. Oftentimes, arterial access for interventional procedures involving iliofemoral targets is via the contralateral common femoral artery. Access to the lesion is then via a crossover technique. This approach avoids many of the potential pitfalls of antegrade punctures or even upper extremity access. However, invariably it involves multiple catheter and wire exchanges to ultimately position a sheath over the aortic bifurcation into the target side that needs to be treated.