The Utilization of Superficial Femoral Artery Access for Transcatheter Aortic Valve Replacement and Peripheral Vascular Interventions: A Systematic Review and Meta-Analysis.

The superficial femoral artery (SFA) is a vascular access alternative for various cardiovascular interventions, especially when the common femoral artery CFA is deep, calcified or in high bifurcation. SFA use, however, was associated with pseudoaneurysms in older literature, and its utilization for large-bore access is not well established. We conducted a systematic review, including randomized and observational studies that reported on SFA vascular access for peripheral arterial disease (PAD), and transcatheter aortic valve replacement (TAVR) from inception until October 2024. The pooled weighted averages of SFA-related vascular complications were calculated. In addition, the random-effects model was used to estimate the pooled odds ratio (OR) comparison between SFA and CFA across the included studies. The primary endpoint was vascular complications. The search yielded 1269 articles; 27 (22 in PAD, 5 in TAVR) met our pre-specified inclusion criteria. Among the PAD studies, 19 were observational, and three were randomized clinical trials. The weighted averages for vascular complications and pseudoaneurysms were 9.8% (95% CI 6.1%-15.6%) and 2.7% (95% CI 1.5%-4.9%), respectively. The meta-analysis included six studies (five observational and one randomized) that compared outcomes of SFA (838 patients) and CFA (604 patients) and showed no significant difference in the rates of vascular complications (5.4% in the SFA group and 6.4% in the CFA group, OR 0.71, 95% CI [0.40-1.27]; p = 0.25%). Among the TAVR studies, SFA was used as the primary access in 18 patients, with no significant bleeding, vascular complications, or unplanned interventions. In this analysis, SFA access was associated with good safety in selected patients undergoing peripheral arterial procedures (low to intermediate risk of bias). It was also feasible as the primary access route for TAVR in a very small, highly selected group with unfavorable CFA anatomy (high risk of bias) and therefore is hypothesis-generating, requiring validation in larger studies.