Antegrade approach for percutaneous interventions of ostial superficial femoral artery: outcomes from a prospective series of diabetic patients presenting with critical limb ischemia

Right femoral artery angiogram taken in ipsilateral oblique view displaying tight stenosis at the ostium of the SFA. This first angiogram obtained by injecting the contrast through a 19G needle located in the common femoral artery (CFA) indicates a short distance between the puncture site and the target lesion (A). Following needle removal and manual compression, a second higher puncture is performed in the CFA within the radiological marker represented by the midfemoral head (dotted line) (B). Final results after PTA and stent placement (Protegé Everflex 7.0×80 mm, ev3, Plymouth, MN, USA; expanded with 6.0-mm balloon at 12 atm, continuous line) in the proximal part of the SFA (C).

Flowchart showing the decision process for approach selection.