Common Femoral versus Superficial Femoral Antegrade Access for Infrainguinal Peripheral Angioplasty – A Comparative Study

Background: Antegrade ipsilateral superficial femoral artery (SFA) access is increasingly used as an alternative to common femoral artery (CFA) access for infrainguinal endovascular interventions. While it provides a direct approach to target vessels and avoids crossing the aortic bifurcation, concerns regarding access-site safety persist. This study compared outcomes of antegrade SFA and CFA access in patients undergoing infrainguinal revascularization for chronic limb-threatening ischemia (CLTI). Materials and Methods: In this retrospective, single-center study, 140 consecutive CFA access procedures and 140 consecutive SFA access procedures performed between January 2021 and June 2024 were analyzed. Baseline characteristics, technical success, stent utilization, additional access requirements, and access-site complications were evaluated. All procedures were ultrasound (US)-guided, with postoperative assessment using duplex US and ankle–brachial index. Results: Baseline characteristics were comparable between the groups. Technical success was achieved in 97.9% (95% confidence interval [CI]: 93.9%–99.6%) of CFA cases and 97.1% (95% CI: 92.8%–99.2%) of SFA cases ( P = 0.687; difference 0.8%, 95% CI: 2.8%–4.4%). Stent deployment was required in 12.1% (95% CI: 7.2%–18.7%) of CFA and 15.7% (95% CI: 10.1%–22.8%) of SFA procedures ( P = 0.49). Overall, access-site complications occurred in 3.6% (95% CI: 1.8%–6.6%), with no significant difference between SFA (4.3%) and CFA (2.9%) access ( P = 0.519). Pseudoaneurysms occurred in 2.1% of patients and were managed conservatively. Conclusions: Antegrade SFA access is a safe and effective alternative to CFA access for infrainguinal interventions in CLTI, offering comparable technical success and low complication rates. With meticulous US guidance, SFA access can be reliably incorporated into routine clinical practice.