ABSTRACT
Indications and contraindications Endovascular treatment of patients with femoral-popliteal atherosclerotic disease is becoming increasingly more common. Antegrade CFA puncture may be useful or desirable for diagnostic angiography, angioplasty, thrombolytic therapy, or use of atherectomy devices. Anatomical considerations where antegrade CFA puncture may be desirable include an acutely angled common iliac bifurcation and aortoiliac grafts where a contralateral femoral approach may be impossible. Contraindications to antegrade CFA puncture include extreme obesity and atherosclerotic disease involving the CFA.
Equipment Equipment necessary to perform antegrade CFA puncture includes a percutaneous needle, a steerable guidewire, and an arterial sheath. A steerable guidewire is desirable to negotiate the CFA bifurcation. A 6-French arterial sheath is the initial size chosen until successful entry is obtained. The sheath size is upgraded if necessary to accommodate larger devices once a treatment plan is formulated.
