Percutaneous femoral puncture for endovascular treatment of occlusive arterial lesions.
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.
Criado
F J
FJ
Division of Vascular Surgery/Endovascular Program, Union Memorial Hospital/Helix Health, Baltimore, Maryland, USA.
Twena
M
M
Halsted
M
M
Abul-Khoudoud
O
O
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