Pre-arteriotomy Guidewire Access (PAGA): A Crucial Maneuver for Securing Inflow and/or Outflow in Patients with Bulky Iliofemoral Occlusive Disease Undergoing Combined (Open/Endovascular) Procedures

Placement of a guidewire across inflow lesions before performing the arteriotomy during combined endovascular/open procedures while treating patients with complex iliofemoral occlusive disease is a crucial maneouvre. We routinely utilize this approach in patients in whom endarterectomy and/or patch angioplasty is planned as the central part of the revascularization procedure, or when we find an unsuspected severely diseased EIA in a patient undergoing leg revascularization.