Antegrade Access to the Superficial Femoral Artery with Ultrasound Guidance: Feasibility and Safety

Abstract

To evaluate the feasibility and safety of antegrade superficial femoral artery (SFA) access with the use of ultrasound (US) guidance. One hundred consecutive patients (56% men) were prospectively enrolled, with a median age of 76 years. The SFA was punctured in antegrade fashion with a 19-gauge needle with US guidance, followed by sheath placement. The time from local anesthesia until successful blood aspiration from the sheath was measured. At the end of the case, hemostasis was achieved with a closure device or by manual compression. All cases were followed with US for access complications. Antegrade arterial access was successful in all cases. The arterial sheath was successfully placed into the SFA in 98 of 100 patients. In 95 of 98, the sheath was inserted with US guidance only; additional fluoroscopy was needed in three cases. In two of 100 patients, the common femoral artery (CFA) was accessed, accidentally in one case and deliberately in the other because the SFA was considered too small. Both patients were excluded from further analysis. The median time for arterial access was 3.5 minutes (interquartile range, 3.1-6.2 min). All complications directly related to vascular access were minor (16; 15.68%): 10 pseudoaneurysms (10.2%; median diameter, 15 mm) and six hematomas (6.12%; median diameter, 31.5 mm). Antegrade puncture into the SFA with US guidance is feasible and fast. The rate of minor complications is similar to other reported series, but a direct comparison with other studies is difficult because study designs vary.