Endovascular Treatment of the Common Femoral Artery for Limb Ischemia

Purpose: To report a new technique to reenter the common femoral artery (CFA) true lumen after retrograde recanalization of a superficial femoral artery (SFA) with flush ostial occlusion. Technique: The technique is demonstrated in a 76-year-old woman with critical limb ischemia previously submitted to several surgical revascularizations. A duplex ultrasound showed flush ostial occlusion of the SFA and patency of the anterior tibial artery at the ankle as the sole outflow vessel. After unsuccessful antegrade attempts to recanalize the SFA, a retrograde guidewire was advanced subintimally up to the CFA, without gaining reentry. A balloon catheter was inflated in the subintimal plane across the SFA ostial occlusion. Antegrade access to the distal CFA was achieved with a 20-G needle, which was used to puncture the balloon. A guidewire was advanced into the balloon and pushed forward while the collapsed balloon was pulled back to the mid SFA. The antegrade guidewire was externalized through a retrograde catheter, which was pushed in the CFA true lumen. A retrograde guidewire was advanced and externalized through the femoral sheath, establishing a flossing wire. The procedure was completed in antegrade fashion. Conclusion: The FORLEE technique is a cost-effective option to gain the CFA true lumen after subintimal retrograde recanalization of an ostial SFA occlusion.

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Endovascular treatment of the common femoral artery in the Vascular Quality Initiative

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.10.078 ◽

2017 ◽

Vol 65 (4) ◽

pp. 1039-1046 ◽

Cited By ~ 24

Author(s):

Jeffrey J. Siracuse ◽

Kathryn Van Orden ◽

Jeffrey A. Kalish ◽

Mohammad H. Eslami ◽

Marc L. Schermerhorn ◽

...

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Common Femoral Artery ◽

The Common

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Endovascular Treatment of Common Femoral Artery Atherosclerotic Disease

Vascular and Endovascular Review ◽

10.15420/ver.2018.7.1 ◽

2018 ◽

Vol 1 (1) ◽

pp. 12-16 ◽

Cited By ~ 1

Author(s):

Omar Jawaid ◽

Ehrin Armstrong

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Common Femoral Artery ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Long Term Outcomes ◽

Patch Angioplasty ◽

The Common ◽

Artery Disease

Common femoral artery atherosclerosis is a common cause of claudication and critical limb ischaemia. Surgical endarterectomy with or without patch angioplasty has been considered the gold standard for the treatment of common femoral peripheral artery disease. Endovascular intervention to the common femoral artery has gained popularity in recent years as devices and technical skills have advanced. A systematic review of the literature from 1987 to 2018 for endovascular treatment of common femoral artery disease was conducted. This article summarises the data on acute and long-term outcomes for endovascular treatment of common femoral artery disease.

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Endovascular treatment of diseases of the common femoral artery: Lumpers and splitters

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.24929 ◽

2013 ◽

Vol 81 (6) ◽

pp. 1023-1024 ◽

Cited By ~ 2

Author(s):

Robert D. Safian

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Common Femoral Artery ◽

The Common

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Ultrasound-guided puncture reduces bleeding-associated complications, regardless of calcified plaque, after endovascular treatment of femoropopliteal lesions, especially using the antegrade procedure: A single-center study

PLoS ONE ◽

10.1371/journal.pone.0248416 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248416

Author(s):

Kentaro Fukuda ◽

Shinya Okazaki ◽

Masayuki Shiozaki ◽

Iwao Okai ◽

Akihisa Nishino ◽

...

Keyword(s):

Endovascular Treatment ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Arterial Disease ◽

Ultrasound Guided ◽

Calcified Plaque ◽

The Common ◽

Ultrasound Guided Puncture ◽

Peripheral Arterial ◽

Guided Puncture

Background A common complication of endovascular treatment for femoropopliteal lesions is bleeding at the vascular access site. Although risk factors of bleeding-associated complications at the approach site have been reported, the results have been inconclusive. Hence, this study aimed to assess the predictors of bleeding-associated complications at the approach site in patients undergoing endovascular treatment for femoropopliteal lesions. Methods This retrospective, single-center, observational study included consecutive patients who underwent endovascular treatment (n = 366, 75% male, 72.4±9.9 year) for peripheral arterial disease with claudication and critical limb ischemia in our hospital from January 2010 to December 2017. We divided the patients into bleeding and non-bleeding groups, depending on whether bleeding-associated complications occurred at the approach site. Bleeding-associated complications were defined according to the Bleeding Academic Research Consortium criteria types 2, 3, and 5. Results Altogether, 366 endovascular treatment procedures and 404 arterial accesses were performed for femoropopliteal lesions in 335 peripheral arterial disease patients with claudication and 69 critical limb ischemia patients. We recorded 35 postprocedural bleeding-associated complications at the approach site (9%), all of which were hematomas. The predictors of increased bleeding-associated complications were age ≥ 80 years (bleeding vs. non-bleeding group, 43% vs. 25%, p<0.05) and antegrade cannulation of the common femoral artery (48% vs. 69%, p<0.05). Ultrasound-guided puncture reduced bleeding-associated complications (odds ratio, 0.28; 95% confidence interval, 0.004–0.21; p<0.05). In contrast, there was no significant difference in puncture site calcification between the groups (bleeding vs. non-bleeding groups, 29% vs. 21%, p = 0.29). Conclusion Ultrasound-guided puncture is associated with a decrease in bleeding-associated complications at the approach site, regardless of the presence of calcified plaque. It is particularly effective and should be more actively used in patients aged ≥80 years and for antegrade cannulation of the common femoral artery.

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Safety and Ease of Sheath Insertion During Endovascular Treatment Via the Common Femoral Artery After Endarterectomy With Autologous Repair: A Retrospective Cohort Study

Vascular and Endovascular Surgery ◽

10.1177/15385744211061904 ◽

2021 ◽

pp. 153857442110619

Author(s):

Sotaro Katsui ◽

Kimihiro Igari ◽

Masato Nishizawa ◽

Toshifumi Kudo

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Common Femoral Artery ◽

Arterial Disease ◽

Scar Tissue ◽

Patch Repair ◽

Simple Closure ◽

The Common ◽

Sheath Insertion ◽

Stiff Guidewire

Background Endovascular treatment (EVT) using the common femoral artery (CFA) for access after endarterectomy (EA) may result in sheath insertion difficulties because of subcutaneous scar tissue, as well as difficulties with hemostasis. We evaluated the safety of CFA access and the ease of sheath insertion over time after EA. Method We included 19 patients (21 limbs, 40 cases) in whom the CFA was used after EA with autologous repair as an access route in EVT for peripheral arterial disease in our institution from January 2013 to December 2020. Nine limbs underwent simple closure repair and 12 underwent autologous patch repair. Difficult sheath insertions were defined as those in which additional devices (stiff guidewire or a smaller diameter sheath for dilation) were used for scheduled sheath insertion. The inability to insert a sheath with the scheduled diameter was defined as a failed sheath insertion. We evaluated the EVT timing after EA for difficult sheath insertions, and whether the CFA was repaired with simple closure or autologous patch repair during EA surgery. Results There were 10 (25%) difficult sheath insertions, with one (2.5%) failure. The rate of difficult sheath insertions peaked from 6 months to 1 year after EA and gradually decreased (47% from 6 months to 3 years, 14% thereafter). There were more statistically significant difficult sheath insertions with simple closure repair (50%) than with autologous patch repair (12%) (P = 0.018). Hemostasis devices were used in 90% of EVT cases. The median maximum sheath diameter was 6 Fr (mean = 5.8 Fr). None of the cases required surgical procedures to achieve hemostasis after EVT. Conclusion EVT may be performed safely using the CFA after EA. The difficulty of sheath insertion may differ depending on the EVT timing after EA; it was more difficult with simple closure than with autologous patch repair, possibly related to scar formation.

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Common Femoral Artery Access: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa192 ◽

2020 ◽

Vol 19 (6) ◽

pp. E594-E594

Author(s):

Maureen A Darwal ◽

Mandy J Binning ◽

Mark Bain ◽

Bernard Bendock ◽

Alan S Boulos ◽

...

Keyword(s):

Vascular Access ◽

Femoral Artery ◽

Cerebral Angiography ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Retroperitoneal Hematoma ◽

Anatomic Landmarks ◽

The Common ◽

Groin Hematoma ◽

Safe Access

Abstract Vascular access for cerebral angiography has traditionally been performed via the common femoral artery. It is crucial to obtain safe access to prevent complications that could lead to limb ischemia, groin hematoma, or retroperitoneal hematoma. This is especially true in neurointervention as many patients are anticoagulated or have received intravenous thrombolytics prior to their intervention. Special attention to anatomic landmarks, both grossly and radiographically, can help to assure safe access. The patient consented for this procedure. This video details rapid but safe femoral artery access in a patient undergoing emergent thrombectomy.

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Endovascular treatment for the common femoral artery: is there a challenger to open surgery?

The Journal of Cardiovascular Surgery ◽

10.23736/s0021-9509.18.10787-7 ◽

2019 ◽

Vol 60 (1) ◽

Cited By ~ 1

Author(s):

Koen Deloose ◽

Igor Martins ◽

Caio Neves ◽

Joren Callaert

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Open Surgery ◽

Common Femoral Artery ◽

The Common

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Kissing Stents in the Common Femoral Artery Bifurcation for Critical Limb Ischemia: Technical Description and Report of Three Cases

Vascular ◽

10.2310/6670.2007.00037 ◽

2007 ◽

Vol 15 (4) ◽

pp. 211-214 ◽

Cited By ~ 12

Author(s):

Sven Ross Mathisen ◽

Michael Åkesson ◽

Mats Lindh ◽

Krassi Ivancev ◽

Timothy A. Resch

Keyword(s):

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Short Term ◽

Number Of Patients ◽

The Common ◽

Kissing Stent ◽

Patch Plasty

The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5–8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography–verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.

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Experience of endovascular treatment of common femoral artery pseudoaneurysm with usage Angio-Seal Closure Device

Endovascular Neuroradiology ◽

10.26683/2304-9359-2019-3(29)-71-79 ◽

2020 ◽

Vol 29 (3) ◽

pp. 71-79

Author(s):

Yu.V. Cherednichenko

Keyword(s):

Endovascular Treatment ◽

Femoral Artery ◽

Common Femoral Artery ◽

Left Vertebral Artery ◽

Closure Device ◽

Severe Stenosis ◽

Femoral Access ◽

Artery Pseudoaneurysm ◽

The Common ◽

The Right

One case of successful treatment of the common femoral artery pseudoaneurysm with usage of modified technique of pseudoaneurysm neck sealing with Angio-Seal with retrograde access percutaneously is presented.A 52-year-old man was admitted in the recovery period of ischemic stroke in the left carotid basin. A total subtraction cerebral angiography was performed, which revealed severe stenosis in the bulb of the left internal carotid artery with ulcerated contour and severe stenosis in the ostium of the left vertebral artery. Hemostasis was performed by compression. A pressure dressing was applied for a day. The puncture site was without any problems on the next day. The patient received double antiplatelet therapy 5 days before endovascular surgery. Before surgery, palpation in the right inguinal region determines a rounded painful compaction. Carotid stenting on the left side, stenting of the left vertebral artery and control angiography of arteries of the right lower limb were performed by left-side femoral access. Pseudoaneurysm in the bifurcation of the right common femoral artery with a narrow neck was verified. Attempts to cure it by manual compression under angiographic control and ultrasound control were unsuccessful.After 6 days, endovascular treatment of pseudoaneurysms of the right common femoral artery with closure of the pseudoaneurysm neck was performed. The right common femoral artery was catheterized with left radial access with diagnostic catheter on a hydrophilic wire 0.035ʺ. This wire was carefully advanced into pseudoaneurysm through a defect in the common femoral artery and subsequently served as a marker. The pseudoaneurysm was punctured with miniaccess needle, then the 0.018ʺ wire passed through the pseudoaneurysm neck into the femoral artery retrogradly, focusing on the “marker” wire. A 6F radial introducer is introduced along 0.018ʺ wire. Further, this access was used to close the pseudoaneurysm neck with the Angio-Seal Closure Device 6F according to the standard method. In a control angiograms, a pseudoaneurysm did not contrast, arteries are passable without stenosis and signs of dissection. Hemostasis at the site of puncture of the radial artery was performed with a hemostatic bracelet. The patient was discharged from the clinic to continue treatment in a rehabilitation neurological center.This technique of endovascular treatment of postcatheterization pseudoaneurysms of the common femoral artery is quite simple, causing minimal discomfort for the patient. The closure is immediate and angiographically controled. The use of radial access instead of contralateral femoral access for introducing of a “marker” wire and angiographic control reduces the risk of local complications at the access site.

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