Achieving safe femoral arterial access

Area of Science:

• Interventional Cardiology
• Vascular Access Management

Background:

• Percutaneous coronary intervention (PCI) frequently utilizes transfemoral access (TFA).
• TFA is preferred for its familiarity and when large bore access is needed or transradial access is anatomically challenging.
• Vascular access complications associated with PCI prolong hospital stays, increase costs, and elevate patient morbidity and mortality.

Purpose of the Study:

• To review strategies for minimizing vascular access complications during PCI via TFA.
• To highlight optimal pharmacotherapy and device usage for safer TFA procedures.

Main Methods:

• Review of current practices and recommendations for TFA in PCI.
• Discussion of imaging modalities (fluoroscopy, ultrasonography, angiography) for precise arteriotomy.
• Analysis of pharmacotherapy (bivalirudin, heparin) and sheath size (<6 Fr) impact.
• Evaluation of vascular closure device efficacy.

Main Results:

• Proper arteriotomy can be achieved using imaging guidance.
• Optimal pharmacotherapy involves bivalirudin and weight-based unfractionated heparin, avoiding supratherapeutic activated clotting times and glycoprotein IIb/IIIa inhibitors.
• Avoiding large arterial sheaths (>6 Fr) and appropriate use of vascular closure devices reduce complication risks.

Conclusions:

• Implementing proper technique, optimal pharmacotherapy, and judicious sheath selection are key to reducing TFA complications.
• Vascular closure devices can effectively decrease bleeding risks when used correctly.
• Further randomized trials are necessary to validate these evidence-based recommendations for TFA in PCI.