Antegrade Access via Superficial Femoral Versus Common Femoral Arteries in Lower Extremity Revascularization: A Comparative Evaluation of Safety and Efficacy

ABSTRACT Background Effective revascularization in lower extremity endovascular interventions depends on reliable arterial access. While the common femoral artery (CFA) is traditionally preferred, anatomical challenges such as calcifications or scarring may necessitate alternative options like the superficial femoral artery (SFA). Aims This prospective, non‐randomized study compares the safety and efficacy of antegrade access through CFA versus SFA in patients undergoing angioplasty. Methods A total of 225 patients were enrolled between 2021 and 2022. Of these, 111 underwent CFA access and 114 underwent SFA access, using a six French sheath in all cases. Sheath placement was guided by duplex ultrasound or fluoroscopy. Use of closure devices was an exclusion criterion. Heparin was administered as either a single dose of 5000 IU or a double dose of 5000 IU at the beginning of the procedure followed by an additional 5000 IU 90 min later, considering the 90‐min half‐life of unfractionated heparin. Procedural variables and complications were analyzed, and crude odds ratios (ORs) were calculated. Results Baseline characteristics, including age, gender, BMI, and comorbidities, were comparable between groups. Duplex‐guided sheath placement was more frequent in the SFA group (47.3% vs. 33.3%). The overall complication rate was significantly lower in the SFA group (3.5% vs. 9.9%, p = 0.033). Most complications, including hematomas and pseudoaneurysms, were observed in the CFA group. No significant predictors of complication could be identified in OR analysis (e.g., duplex guidance OR: 0.551; 95% CI: 0.226–1.348). Conclusion Antegrade SFA access demonstrated a safety profile comparable to CFA access and may serve as a suitable alternative, especially when CFA access is technically difficult. The low complication rate and increased use of duplex guidance highlight its potential utility in endovascular procedures.