1. The wire not advancing further.
What is the next best step?
1. Call vascular
surgery
2. Switch to radial
access
3. Deploy covered
stent
4. Retract and
redirect wire

2. The wire not advancing further.
What is the next best step?
1. Call vascular
surgery
2. Switch to radial
access
3. Deploy covered
stent
4. Retract and
redirect wire

3. Deep
circumflex
iliac
Inf.
epigastric
Common
femoral
Deep femoral
(profundis)
Figure 1. Guidewire in deep circumflex iliac
artery
Superficial
femoral
Figure 2. Femoral access angiographic
anatomy
Correct Answer:
Retract and redirect wire
The lateral course of the guidewire suggests
that is located in the deep circumfex iliac
artery (Figure 2). Inserting a sheath over
the guidewire into this small branch could
result in perforation. Simple wire
redirection was successful in advancing the
guidewire into the right external iliac artery
(Figure 3).
Figure 3. Wire retracted and redirected
Option 1: Calling vascular surgery is not necessary unless a
perforation is confirmed with contrast extravasation that cannot
be controlled in the cath lab.
Option 2: Switching to radial access is possible, but will likely
not be necessary if simple wire redirection achieves the goal of
safely obtaining femoral arterial access.
Option 3: Covered stent deployment is also not required, since
no perforation has occurred; moreover, stent implantation in
the common femoral artery is suboptimal as it is prone to
fracture.