PERCUTANEOUS FEMORAL PUNCTURE FOR ENDOVASCULAR TREATMENT OF OCCLUSIVEARTERIAL LESIONS

BACKGROUND: Percutaneous femoral arterial access is a most important a nd difficult aspect of endovascular intervention, and the source of mo st complications. METHODS: A retrospective review was made of the auth ors' 9-year experience with 755 femoral punctures for the endovascular treatment of occlusive disease. The main focus was the evolving succe ss rate with percutaneous arterial entry and the incidence of access-r elated 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 endovasc ular intervention. Practicing vascular surgeons can expect a significa nt learning curve. Performance can be optimized through intensive basi c and advanced training and preceptorship. The cutdown approach is nei ther necessary nor acceptable for most endovascular procedures. Am J S urg. 1998;176:119-121. (C) 1998 by Excerpta Medica, Inc.