Vascular access

Abstract

This chapter describes the percutaneous techniques of antegrade femoral artery access, contralateral iliofemoral artery access, and popliteal artery access. Endovascular treatment of atherosclerotic peripheral vascular disease is most commonly approached via the common femoral artery. The chapter explores the popliteal anatomy, the technique of popliteal access and its indications. The anatomy of the popliteal fossa when performing percutaneous popliteal artery access to prevent the creation of an arteriovenous fistula. The popliteal artery, vein and sciatic nerve are encased in a common sheath, which courses upwards along the diagonal of the popliteal fossa. As any arterial puncture, hematomas occur at rates of 2-4% when popliteal artery access is used. The anatomic relationship of the popliteal artery to popliteal vein increases the risk of arteriovenous fistula due to transvenous arterial puncture. Complications of contralateral iliofemoral artery access are most commonly related to the retrograde common femoral artery puncture. They include pseudoaneurysms, arteriovenous fistulas, thromboembolism, infection, retroperitoneal hematomas and bleeding complications.