Verification of the safety of large-diameter sheath insertion in anterolateral popliteal artery puncture.

Introduction: Endovascular therapy (EVT) strategies have been developed, and complex lesions can often be revascularized using antegrade wiring. However, there are situations in which the distal artery approach is required. Anterolateral popliteal artery (PA) puncture has many advantages, such as ease of puncture and ability to be performed in the supine position. However, there is hesitancy to use sheaths larger than 4.0 Fr because of the risk of bleeding complications due to the long distance from the skin to the PA. Aim: To evaluate the safety of sheath insertion via anterolateral popliteal artery puncture. Material and methods: We retrospectively reviewed the devices and outcomes of 14 patients who underwent EVT with a wide sheath inserted during anterolateral PA puncture at our institution and introduced a hemostatic method. Results: A total of 179 EVTs were performed at our institution, 14 of which involved anterolateral PA puncture. 4.0-6.0 Fr sheaths were used, and the PA was ballooned for 10 min during sheath removal. The dorsal PA was compressed with hemostatic compression cotton, and the anterior puncture site was compressed with Stepty (NICHIBAN, Tokyo, Japan) and fixed together with an adhesive elastic bandage. There were no complications, such as hematoma formation or compartment syndrome, in all 14 patients. Conclusions: The safety of insertion of a wide-diameter sheath in anterolateral PA puncture has been recognized and is expected to expand the range of treatment strategies for EVT using the anterolateral PA approach.