title: Percutaneous femoral puncture for endovascular treatment of occlusive arterial lesions.
abstract: BACKGROUND
  Percutaneous femoral arterial access is a most important and difficult aspect of endovascular intervention, and the source of most complications.
  
  
  METHODS
  A retrospective review was made of the authors' 9-year experience with 755 femoral punctures for the endovascular treatment of occlusive disease. The main focus was the evolving success rate with percutaneous arterial entry and the incidence of access-related complications.
  
  
  RESULTS
  Cutdowns were frequent during the first 2 years, 54% and 17%, respectively, decreasing to 5% or lower by the third year. The incidence of femoral hematoma and other complications mirrored the same learning curve. After cutdown, wound infections and lymph leakage occurred in 2.4% each, and prolonged significant pain in 5%.
  
  
  CONCLUSIONS
  Percutaneous puncture is a crucial skill in endovascular intervention. Practicing vascular surgeons can expect a significant learning curve. Performance can be optimized through intensive basic and advanced training and preceptorship. The cutdown approach is neither necessary nor acceptable for most endovascular procedures.
authors.affiliation: Division of Vascular Surgery/Endovascular Program, Union Memorial Hospital/Helix Health, Baltimore, Maryland, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Criado
authors.forename: M
authors.initials: M
authors.lastname: Twena
authors.forename: M
authors.initials: M
authors.lastname: Halsted
authors.forename: O
authors.initials: O
authors.lastname: Abul-Khoudoud
mesh_terms: D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002404:Catheterization; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D011677:Punctures; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects