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. Am J Surg. 1998;176:119-121. (C) 1998 by Excerpta Medica, Inc.