Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil.
Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil.
J Vasc Surg. 2021 Sep;74(3):763-770. doi: 10.1016/j.jvs.2021.02.029. Epub 2021 Mar 5.
Antegrade access for infrainguinal endovascular intervention can be achieved through the common femoral artery (CFA) or superficial femoral artery (SFA). A few studies with small sample sizes have shown similar efficacy and safety for antegrade puncture of the CFA and SFA. In the present study, we analyzed the feasibility of SFA access and the occurrence of complications between SFA and CFA ipsilateral access in a broader cohort.
In the present retrospective study, we analyzed data from 462 patients with peripheral arterial disease (PAD) who had undergone peripheral angioplasty from 2009 to 2016. The inclusion criteria were PAD at Rutherford stage 3 to 6 and use of an endovascular approach. Patients with coagulation disorders, those receiving anticoagulant therapy, cases with deployment of closure devices, cases with more than one access on the same limb, and patients with inadequate bed rest after the procedure were excluded. A systematic analysis of all patients' electronic medical records was performed to evaluate the demographic aspects and technical success and identify the possible complications associated with CFA and SFA access.
Of the 462 patients, 290 had undergone SFA puncture and 172, CFA puncture. The demographic evaluation of both groups revealed no differences between the two groups, except that more patients with diabetes were in the CFA group and more patients with dyslipidemia and an advanced clinical presentation were in the SFA group. First puncture access was successful in 99.7% of the SFA group and 96.5% of the CFA group (P = .01). The hematoma rate in the SFA and CFA groups was 20.3% and 11%, respectively (P = .01). The incidence of major bleeding and clinically relevant nonmajor bleeding was not significantly different between the two groups (P = .215). Only three patients had developed a pseudoaneurysm, two of whom were in the SFA group. Female sex (odds ratio [OR], 2.572; 95% confidence interval [CI], 1.520-4.354; P < .001] and older age (OR, 1.034; 95% CI, 1.009-1.059; P = .007) were associated with an increased hematoma rate.
SFA access was associated with a higher overall rate of hematoma compared with CFA access. However, no significant difference was found in the incidence of major bleeding between the two access sites. Planned SFA access should be considered as an alternative to CFA access.
下肢血管腔内介入治疗的顺行入路可以通过股总动脉（CFA）或股浅动脉（SFA）进行。少数样本量较小的研究表明，CFA 和 SFA 顺行穿刺的疗效和安全性相似。本研究在更广泛的队列中分析了 SFA 入路的可行性以及 SFA 和 CFA 同侧入路的并发症发生情况。
本回顾性研究分析了 2009 年至 2016 年间接受外周血管成形术的 462 例周围动脉疾病（PAD）患者的数据。纳入标准为 Rutherford 3 至 6 期 PAD 且采用血管内治疗。排除标准为凝血障碍、抗凝治疗、使用封堵装置、同一肢体上有多个入路、术后卧床休息不足。对所有患者的电子病历进行系统分析，以评估人口统计学方面和技术成功情况，并确定与 CFA 和 SFA 入路相关的可能并发症。
462 例患者中，290 例行 SFA 穿刺，172 例行 CFA 穿刺。两组患者的人口统计学评估显示，两组之间没有差异，但 CFA 组中有更多的糖尿病患者，SFA 组中有更多的血脂异常和晚期临床表现患者。SFA 组的首次穿刺成功率为 99.7%，CFA 组为 96.5%（P=0.01）。SFA 和 CFA 组的血肿发生率分别为 20.3%和 11%（P=0.01）。两组之间主要出血和临床相关非主要出血的发生率无显著差异（P=0.215）。只有 3 例患者发生假性动脉瘤，其中 2 例在 SFA 组。女性（比值比 [OR]，2.572；95%置信区间 [CI]，1.520-4.354；P<0.001）和高龄（OR，1.034；95%CI，1.009-1.059；P=0.007）与血肿发生率增加相关。
与 CFA 入路相比，SFA 入路总体血肿发生率更高。然而，两个入路部位的主要出血发生率无显著差异。计划的 SFA 入路可作为 CFA 入路的替代方案。
