Alex Mortimer MBCHB, MRCS, Presenter: Nothing to Disclose

Muhammad Asad Hanif MBBS, Abstract Co-Author: Nothing to Disclose

Steven Morgan, Abstract Co-Author: Nothing to Disclose

John-Luke Cook MBBS, Abstract Co-Author: Nothing to Disclose

Bilateral and/or unilateral concurrent lesions of the iliac and superficial femoral arteries are common. Convention is to angioplasty lesions proximal and distal to the femoral puncture on two different occasions. Puncture reversal allows treatment of this pattern of disease in one sitting. However, only small series data (maximum 29 cases) regarding its safety and efficacy has been published previously. At our institution, this technique is commonly employed. We aim to compare complication rates to national standards described in the literature.  

166 patients underwent femoral puncture reversal between 2003 and 2009 using a technique descrbed by Hartnell (1998). Following retrograde access and treatment of either ipsilateral iliac or contralateral disease, the technique involves using a Sims 2 or Contra 2 catheter within the external iliac artery to guide a hyrophillic wire distally and then advance both catheter and sheath over the wire. Complication data was collected by retrospective analysis of electronic case notes and the PACS system and this was compared to recognised peripheral angioplasty complication rates published by the RCR (2008). 

Of 166 patients, 59 were female (35.5%) and 107 male (64.5%). The mean age was 69 years, range 40 to 90 years. 289 lesions were treated. Puncture reversal was not technically possible in 6 patients (3.6%).  Operative intervention for local haematoma was requird in two cases (1.2%) and a single pseudoanueyrsm (0.6%) was treated with local thrombin patch. Vascular occlusion requiring surgical evacuation of thrombus was seen in one patient (0.6%) and requiring catheter-guided thrombolysis in another (0.6%). Distal embolisation complicated two cases (1.2%); neither required further intervention. No limb loss occurred. None of these values are outwith the 95% confidence intervals stated in the RCR guidelines for standards in iliac angioplasty. 

Femoral puncture reversal allows treatment of multiple lesions: both bilateral and concurrent iliac and more distal disease in one sitting.  Our results suggest that complication rates are not outwith recognised standards and therefore this is a safe and potentially very useful technique.

Bilateral or concurrent iliac and femoral lower limb vascular disease is common.  Femoral puncture reversal allows treatment of multiple lesions in one sitting without in excessive complication.

Mortimer, A, Hanif, M, Morgan, S, Cook, J, Femoral Puncture Reversal Is a Useful, Safe Technique for Treatment of Bilateral or Concurrent Unilateral Iliac and Femoral Arterial Disease in a Single Sitting.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9002014.html