====== Femoral artery approach ======

The [[femoral artery]] is the most common access route for [[cerebral angiography]] and [[neurointervention]]al [[procedure]]s. [[Complication]]s of the [[transfemoral]] [[approach]] include [[groin]] [[hemorrhage]]s and [[hematoma]]s, [[retroperitoneal hematoma]]s, [[pseudoaneurysm]]s, [[arteriovenous fistula]]s, [[peripheral artery]] occlusions, [[femoral nerve injury]], and access-site [[infection]]s. [[Incidence]] [[rate]]s vary among different [[randomized]] and nonrandomized [[trial]]s, and the [[literature]] lacks a [[comprehensive review]] of this subject.

Oneissi et al. gather data from 16 [[randomized clinical trial]]s (RCT) and 17 nonrandomized [[cohort]] studies regarding femoral access-site complications for a review [[paper]]. They also briefly discussed [[management]] strategies for these [[complication]]s based on the most recent [[literature]].

A [[PubMed]] indexed search for all [[neuroendovascular]] [[clinical trial]]s, [[retrospective]] studies, and [[prospective]] studies that reported femoral artery access-site complications in neurointerventional procedures.

The overall access-site complication rate in RCTs is 5.13%, while in non-RCTs, the rate is 2.78%. The most common complication in both groups is [[groin hematoma]] followed by access-site hemorrhage and [[femoral artery pseudoaneurysm]]. On the other hand, [[wound infection]] was the least common complication.

The [[transfemoral]] approach in [[neuroendovascular]] [[procedure]]s holds risk for several complications. This review will allow further studies to compare access-site complications between the transfemoral approach and other alternative access sites, mainly the [[trans-radial artery approach]], which is gaining a lot of interest nowadays
((Oneissi M, Sweid A, Tjoumakaris S, Hasan D, Gooch MR, Rosenwasser RH, Jabbour 
P. Access-Site Complications in Transfemoral Neuroendovascular Procedures: A
Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg
(Hagerstown). 2020 May 4. pii: opaa096. doi: 10.1093/ons/opaa096. [Epub ahead of 
print] PubMed PMID: 32365203.
)).
----
[[Femoral artery]] [[approach]] is the main access in [[stenting]] of carotid artery, mainly due to rapid [[training]] in how to perform the [[procedure]] and a possibility of using large-diameter [[catheter]]s. 

However, this approach is not always feasible in [[atherosclerosis]], tortuosity of lower-limb arteries and in certain anatomical peculiarities of the [[aortic arch]]. Using a [[trans-radial artery approach]] is based on the desire to diminish the incidence rate of haemorrhagic complications in the zone of the puncture and to avoid the necessity of a long-term bed rest. The findings obtained in numerous studies of coronary stenting and in a series of works on stenting of carotid arteries have demonstrated that the transradial approach reduces the risk of haemorrhage and local vascular complications. 

A study from Shchanitsyn et al., was aimed at comparative analysis of the transradial versus transfemoral approach used in carotid [[stenting]]. They retrospectively analysed the results of transradial and transfemoral stenting of [[carotid artery]] in a total of 168 patients. The operations had been performed in two centres over the period from 2012 to 2017. They evaluated the clinical and angiographic data, technical aspects of the operations, as well as the outcomes and complications. In particular, they compared such [[complication]]s as [[stroke]], [[transient ischemic attack]], [[myocardial infarction]] and local complications of the approach. They carried out a univariate analysis of the risk for the development of complications depending on the method of the approach. Stenting of carotid arteries had been performed in 75 patients through the [[radial artery]] approach and in 93 patients via the femoral one. Comparing the two groups, the main clinical and angiographic data appeared to have no statistically significant differences. Various techniques of catheterization had been used depending upon anatomical peculiarities. The success of the procedure was achieved in 100% of cases, with the frequency of conversion amounting to 4% for the radial approach and to 1% for the femoral one (p=0.087). Amongst complications encountered, disabling stroke was revealed in two (1.2%) patients and minor stroke in four (2.4%). The groups did not differ by the incidence of neurological complications. Within 30 postoperative days neither lethal outcomes nor myocardial infarction were registered. Neither were there haemorrhagic events or other approach-related complications, however in the transradial-approach group, seven (9.3%) patients were found to have developed asymptomatic occlusions of the radial artery. The duration of the operation, the radiation load, and the length of hospital stay had no statistically significant differences depending on the approach used. Hence, the transradial approach is an effective and safe method in stenting of carotid arteries. In patients with high risk of haemorrhagic complications from the side of the vascular approach and with difficult anatomy of the aortic arch and its branches, hampering catheterization of the carotid artery via the femoral approach, the radial artery may be considered as an advantageous site of access
((Shchanitsyn IN, Sharafutdinov MR, Iakubov RA, Larin IV. [Transradial approach 
in carotid stenting]. Angiol Sosud Khir. 2018;24(2):114-122. Russian. PubMed
PMID: 29924782.
)).

===== References =====