Access and closure management of large bore femoral arterial access

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Vascular Access Techniques

Background:

• Femoral and radial artery access are standard for percutaneous coronary interventions.
• Despite technological advancements, bleeding and vascular complications remain significant, particularly with large-bore access.
• Effective hemostasis techniques for large-bore arterial access are not well-documented.

Purpose of the Study:

• To describe a protocol for large-bore femoral artery sheath insertion and management.
• To highlight techniques for safe vascular access and effective hemostasis in high-volume interventional procedures.

Main Methods:

• Detailed description of a protocol for femoral artery large-bore sheath insertion.
• Includes site identification, device selection, insertion, limb perfusion assessment during mechanical circulatory support (MCS), and hemostasis.
• Protocol implemented at a high-volume tertiary care center.

Main Results:

• Large-bore femoral artery access is feasible and safe when a protocol is followed.
• Associated with low complication rates, even in complex procedures with prolonged MCS support.
• Specific techniques ensure effective hemostasis post-sheath removal.

Conclusions:

• A structured protocol for large-bore femoral artery access and sheath management leads to safe procedures.
• This approach effectively minimizes vascular complications in interventional cardiology.
• The described techniques are crucial for centers performing high-volume endovascular and structural heart interventions.