Technical endovascular highlights for crossing the difficult aortic bifurcation

Effective endovascular treatment requires successful vascular access to reach the targeted lesion. When the targeted lesion is infrainguinal in location, the vascular access options include the ipsilateral antegrade femoral approach, the contralateral retrograde femoral approach, or the transbrachial approach. The contralateral retrograde femoral route remains the most commonly used approach but may be challenging, particularly in the settings of a scarred groin or a difficult aortic bifurcation. The purpose of this article is to provide technical tips for the challenges encountered in obtaining contralateral femoral access for peripheral interventions with a difficult aortic bifurcation.