Modified Two Wire Technique Using Fogarty Catheter in Antegrade Femoral Access.

Abstract

Antegrade femoral access is a routinely used technique for infra-inguinal interventions. However, it can be challenging in cases of high femoral bifurcations, obliterative disease process and obese patients. A simple method of antegrade access using a Fogarty catheter and guide wires, under flouroscopic control is presented , which has lead to easy access in obliterative disease of SFA with minimal complications. We have done fourteen successful punctures using this technique over the past 6 months. In obese patients or patients with a pannus another assistant was used to pull the pannus back while doing the procedure. However, in two cases, while withdrawing the sheath into the CFA, there was inadvertent slippage of sheath outside the lumen of CFA. Immediate haemostasis was ensured by pulling the inflated Fogarty catheter backwards followed by manual compression before reintroducing the sheath inside the lumen. In both these cases, the patients were obese with a pannus and our puncture angle was more vertical which most probably led to this complication. However, post intervention results were satisfactory with no evidence of any pseudoaneurysm formation. This simple method allows to achieve antegrade SFA access in a safe and secure manner.