The wise radialist's guide to optimal transfemoral access: Selection, performance, and troubleshooting

Abstract

Transradial access (TRA) has reduced vascular access-site complication (VASC) and bleeding rates in patients undergoing coronary angiography and intervention. A "radial-first" approach should be adopted and indications of TRA extended in order to maximize its beneficial effect. However, in certain clinical scenarios, transfemoral access (TFA) is a preferable or a mandatory route to successfully perform the procedure. Since the widespread adoption of TRA, a paradoxical increase in VASC rates has been observed in patients undergoing TFA, which might be attributed to a combination of increased risk profile of both the procedures and the patients, and a loss of skills in securing TFA by those who are now default radial operators. In the present article we provide recommendations on how to optimize patient selection for TRA and TFA, how to manage access site crossover, and how to perform state-of-the-art femoral artery puncture. © 2016 Wiley Periodicals, Inc.

Educational Experience of Interventional Cardiology Fellows in the United States and Canada

“…State-of-the-art femoral access requires the use of fluoroscopy, ultrasound, a micropuncture needle, femoral angiography, and vascular closure devices, which play a role in the optimization of patient outcomes. 13 , 14 , 15 , 16 In our survey, however, only 65% reported regular use of ultrasound for femoral access, and 19% reported using ultrasound <50% of the time for femoral access. In contrast, in a 2016 survey of interventional cardiologists, despite the availability of ultrasound and technical expertise, only 13% reported routine use of ultrasound for femoral access, 17 indicating that there is room for improvement in ultrasound use.…”

Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta‐analysis

“…It is arguable that this transition in practice might translate into higher complication rates when FA access is required . Considering the unfavorable prognosis conferred by FA access site bleeding following percutaneous coronary intervention (PCI), any strategy aiming at optimizing the technique is desirable …”

“…Inadvertent sheath insertion beyond the common FA (CFA) boundaries increases rates of FA access complications . In that regard, real‐time visualization with ultrasound (US) has been proposed as a strategy to optimize the technique . US‐guided vascular access has become a standard of practice in the intensive care and emergency room settings.…”

Percutaneous artErial closure devices and ultrasound‐guided Trans‐femoRal puncture ObservatioNal InvestigatiOn: Insights from the PETRONIO registry

“…Previous trials have shown the potential benefit of ultrasound guidance and VCD for femoral artery puncture when taken individually as compared to traditional approaches. 19 The FAUST trial is a multicentre randomized trial showing that ultrasound guidance reduced the number of attempts, time to access, risk of venipunctures, and vascular complications in femoral arterial access. U technique improved common femoral artery cannulation only in patients with high common femoral artery (CFA) bifurcations.…”