Abstract No. 442 Femoral flip: reversible femoral access

Abstract

To describe a technique for bidirectional reversal of femoral access that allows diagnostic aorta and lower extremity arteriography and antegrade intervention from a single puncture, with on label retrograde use of closure device. From 5/1/2015 to 5/1/2017 33 infrainguinal arterial interventions were performed on 32 patients using a reversible femoral access technique. 19 males and 13 females were treated, ranging in age from 52 to 92, mean 75. The technique used was as follows: Common femoral artery is punctured with a vertical needle orientation, an Omni-flush catheter (Angiodynamics, Queensbury, NY) was placed in the lower aorta and diagnostic arteriography was carried out. Access was reversed from retrograde to antegrade using the Omni-flush catheter. Intervention was performed. In 28 of 33 cases, access was then reversed to retrograde using a Hastings U-turn catheter (Angiodynamics, Queensbury, NY), enabling on-label use of a closure device. In the remaining 5 cases, the sheath was removed and manual pressure was applied. Technical success for reversing access was achieved in all cases. Technical success of angioplasty or stenting, defined as in-line flow to the foot, was achieved in 28 of 33 cases (85%). There were 2 complications (6%), both self-limited groin hematomas. Femoral flip is a safe technique that allows the superior tactile control and pushing ability of antegrade intervention, while doing a full diagnostic arteriogram and on-label retrograde use of closure device from a single ipsilateral femoral puncture.