Antegrade Vs cross over femoral artery access in the endovascular treatment of femoropopliteal lesions in patients with critical limb ischemia

Critical limb ischemia (CLI) is considered the “end-stage” of peripheral arterial disease. CLI is classically cured with revascularization due to lack of effective medical treatment  for recover of threatened legs. The common femoral artery (CFA) access most commonly used for endovascular treat- ment of lower limb lesions, and antegrade CFA access used for interventional rather than diagnostic purposes. Security and efficiency of antegrade against cross over femoral en- tree in the endovascular management of superficial femoral artery and popliteal artery lesions. In this study, a total of (82) patients with critical limb ischemia studied between October 2018 and September 2019 and divided into two groups, Group one (G1) 54 patients underwent endovascular treatment for femoropopliteal lesion through antegrade femoral access, those compared with the group tow (G2) 28 patients where underwent endovascular treatment for femoropopliteal lesion through the cross over femoral access. The comparison includes crossing success, the incidence of complications, fluoroscopy time and contrast volume. In this study, 82 patients (62 male and 20 female) with a mean age (60.9 years), with a high prevalence of peripheral arterial disease risk factors: diabetes, hypertension, obesity and smoking. Antegrade femoral access used in 54 patients, cross over femoral access used in 28 patients. Overall, crossing success rate is higher in the antegrade femoral access than cross over femoral access (70.37% vs. 60.71% respectively). Fluoroscopy time and contrast volume used in the cross over technique was significantly higher compared to the antegrade femoral technique. (6.6% vs. 7.1%) patients suffered from access site hematoma (antegrade vs. cross over respectively). Only one patient suffered from wound infection at the access site in the antegrade group. Ante grade femoral access appears to be safe and can be used effectively for the crossing of the superficial femoral artery and popliteal artery lesions in patients with critical limb ischemia.