The Role of Profunda Femoral Artery Retrograde Puncture in Complex Revascularization of Ileo-Femoral Chronic Total Occlusions

Introduction: The profunda femoral artery (PFA) puncture is generally fraught with risk of bleeding and iatrogenic damage, leading to possible impaired flow in such a valuable artery. However, the PFA represents a potential retrograde path to the common femoral artery (CFA) due to its usual good size and convenient location. Since endovascular treatment of the CFA and its bifurcation is gaining popularity, this study intends to report the use of PFA access in complex revascularizations.Materials and Methods: This is a retrospective multicenter registry on PFA retrograde approaches, including 15 cases in which this access was used during challenging recanalizations of iliac and femoral chronic total occlusions (CTO). This access was performed as a bailout in 11 cases (73.3%). The puncture's technical success and the diseased segments' recanalization were achieved in all cases. Hemostasis was done by intraluminal balloon inflation (9/15, 60%), external manual compression (4/15, 26.7%), or closure device deployment (2/15, 13.3%). No complications related to the access were noted.Conclusion: This series represents the largest cohort of patients who underwent retrograde PFA puncture for iliac and femoral CTO crossing. It shows how different clinical and anatomical settings may suit this endovascular approach, making it a safe alternative that vascular specialists should be aware of.Clinical Impact Retrograde puncture of the profunda femoral artery (PFA) could represent a strategic approach during complex iliac and femoral endovascular revascularizations and total endovascular femoral reconstruction. This article presents 15 cases of PFA retrograde puncture and conveys technical tips for performing this maneuver correctly and avoiding potential risks at the level of this vessel. Surgeons and interventionalists should be aware of this possibility, especially with the increasing number of total endovascular treatments of the femoral bifurcation.