Retrograde Tibialis Anterior Artery Access as an Alternative Route for Stent-Based Endovascular Repair of Femoral Access-Site Complications

BackgroundFemoral arterial access can lead to complications, including bleeding, pseudoaneurysms, arteriovenous fistulas (AVFs), and dissections. When utilizing endovascular methods, the treatment of these complications is typically performed via contralateral femoral access. For appropriate patients, the tibialis anterior (TA) approach offers a promising alternative, providing distal access with minimal risk of complications. This study evaluates the single retrograde TA approach for managing femoral artery access complications.Patients and MethodsA single-center retrospective analysis was conducted, including 11 patients who underwent endovascular treatment for femoral access complications via a single ipsilateral TA approach. Baseline demographics, procedural characteristics, and outcomes were collected from hospital records. Technical success was defined as the ability to obtain retrograde tibialis anterior access, advance a catheter to the target site, and deliver the intended therapy. Procedural success was defined as effective treatment of the vascular injury with preservation of patency in both the treated vessel and the tibialis anterior artery used for access.ResultsEleven patients (median age, 73 years; 55% male) underwent stent-based endovascular treatment. The most common vascular injuries were pseudoaneurysms (45%) and arteriovenous fistulas (45%), most often involving the superficial femoral artery (82%). All procedures achieved 100% technical and procedural success. The median procedure time was 50 minutes (IQR: 37-73), and the median fluoroscopy time was 4.4 min (IQR: 2.4-7.3). During 30-day follow-up, one Class B adverse event (vasovagal reaction) and one Class D adverse event (intracranial hemorrhage, unrelated) were observed. No reinterventions, permanent sequelae, or deaths occurred.ConclusionThe single retrograde TA artery approach demonstrates high technical and procedural success, providing an effective alternative for managing femoral access complications. Further multicenter studies are needed to validate these findings and explore long-term outcomes.