Antegrade access: Choose the right operator and the right patient

We welcome the study by Wheatley et al1 comparing antegrade vs retrograde femoral access for endovascular lower limb procedures. However, we believe that their conclusion that the antegrade access is more likely to result in complications and should be used cautiously is inaccurate and biased. Indeed, despite their prospective data collection and careful analyses, they failed to recognize the importance of key operator and patient features that make antegrade access, respectively, remarkably safe and mandatory in at least selected cases.