Iliofemoral Stenting: Decision-Making & Best Practices Explored

[Dr. Kush Desai]
There's a lot of different ways to do this. A lot of my vascular surgery colleagues are doing mid-thigh femoral access. Actually, my colleagues too, a lot of them do mid-thigh femoral access. I think the way I was "raised" and the way I've done procedures is if it's a post-thrombotic and there's an inflow lesion, particularly the common femoral vein, I do it under prone access, and I access typically small saphenous.

If it's not a posterior thigh extension of Giacomini vein, if there's a Saphenopopliteal junction. I like the small saphenous vein because primarily if we know that the active access is traumatic in of itself, particularly with some of the larger sheaths that some of these devices require, if I'm going to bag a vein, might as well bag the vein that people close for a living. Posterior tibial vein and then begrudgingly popliteal vein after that.

I will say that access management with closure and all that, that's probably where we need to come the furthest with venous. We have venous closure devices. I think those need to be studied in our interventions more and more, particularly with the level of anticoagulation that we're using because access-like complications not frequently talked about, but they do occur.