Retrograde Pedal Artery Access versus Conventional Common Femoral Artery Access in Isolated Superficial Femoral Artery Lesions

Aim: The current study compared the efficacy and safety of retrograde pedal artery (PA) access versus conventional common femoral artery (CFA) access in managing isolated superficial femoral artery (SFA) occlusions or severe stenoses. Materials and Methods: A retrospective analysis was conducted on 34 patients treated between June 2020 and November 2023. The patients were categorized into two groups: 12 patients with PA access and 22 with CFA access. Technical success, complication rates, stent usage, procedure duration, and radiation doses were analyzed. Results: Technical success was achieved in 92.8% of the patients in the PA access group and 84% of the CFA access group (p = 0.636). Complications at the access site were significantly lower in the PA access group, with no hematomas or pseudoaneurysms observed, while both hematomas (32%) and pseudoaneurysms (16%) were noted in the CFA group (p = 0.033). Stent usage was similar between the two groups (21.4% PA vs. 28% CFA, p = 0.721). Median procedure durations were 43 minutes (IQR 27.5–59) for PA and 47 minutes (IQR 29–64) for CFA (p = 0.446). Median total air kerma dose was 280 mGy (IQR 166.5–326.75) for PA and 225 mGy (IQR 145–489) for CFA (p = 0.826). Conclusions: Retrograde PA access is a viable and safe alternative to CFA access, particularly for patients with complex femoral anatomy, offering similar efficacy with fewer access site complications.