Technical Note A simplified technique for converting antegrade femoral access to retrograde access for catheterization Salik Nazir 1 , Ahmed M Elzanaty 2 and George V Moukarbel 1 Abstract Objectives: Femoral access conversion is sometimes required in clinical practice. Various techniques have been reported to convert a retrograde femoral access to antegrade access with a high success rate. However, despite paucity of data, converting an antegrade access to retrograde access is quite challenging with a potentially higher risk of technical failure or loss of access. Methods: Here, we report a simple technique of antegrade to retrograde access conversion utilizing a pigtail catheter and an angled Glidewire. Results: Successful conversion was achieved with no immediate complications with the proposed technique. Conclusions: Techniques that describe antegrade to retrograde access conversion are seldomly reported in the medical literature. Our technique was successful in making the conversion utilizing only pigtail catheter and angled Glidewire. Keywords Femoral access, antegrade to retrograde access, coronary angiography Introduction Various techniques have been reported to convert a retrograde femoral access to antegrade access with a high success rate. 1–4 However, despite paucity of data converting an antegrade access to retrograde access has been reported to be quite challenging, with a potential- ly higher risk of technical failure or loss of access. 2 A “buddy wire” technique, utilizing a stiff wire was pre- viously described. 2 Here, we report a simple technique of antegrade to retrograde access conversion utilizing a pigtail catheter and an angled Glidewire. Case presentation A 59-year-old man with medical history of essential hypertension, hyperlipidemia, type 2 diabetes mellitus, and coronary artery disease was admitted at our insti- tute for unstable angina. He was planned for coronary angiography and possible revascularization. In our car- diac catheterization laboratory, we typically use a Cook Medical micropuncture VR access kit which allows us to confirm adequate access site, without com- mitting to a larger bore femoral access. Access was obtained in the right common femoral artery using the micropuncture technique, and adequate access location was confirmed by angiography via the micro- puncture inner dilator. The access was then upsized to a standard 6-French sheath. At this point, it was noted that the access was unintentionally flipped to the ante- grade direction in the right superficial femoral artery, likely related to the wire flipping downward while upsizing from the micro-puncture to the regular sheath (Figure 1). In order to revert to retrograde access, a 5-French pigtail catheter was advanced just distal to the sheath, and a Terumo angled Glidewire was directed up towards the common femoral artery using the curvature of the pigtail catheter. The tip of the sheath and the pigtail catheter were gently 1 Division of Cardiovascular Medicine, University of Toledo, Toledo, USA 2 Department of Internal Medicine, University of Toledo, Toledo, USA Corresponding author: George V Moukarbel, Interventional Cardiovascular Medicine, University of Toledo, 3000 Arlington Avenue, Toledo, OH 43614, USA. Email: george.moukarbel@utoledo.edu Vascular 0(0) 1–3 ! The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1708538120939730 journals.sagepub.com/home/vas