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Updated: Nov 12, 2025

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Vascular Access for Large Bore Access.

Stephen McHugh¹, Ali Noory¹, Suraj Mishra¹

¹Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA.

Interventional Cardiology Clinics

|March 22, 2021

Summary

This summary is machine-generated.

Safe large bore vascular access is crucial for complex percutaneous interventional cardiology procedures. Understanding anatomy, using imaging guidance, and proper closure techniques ensure success and minimize complications.

Keywords:

Hemostasis Large bore Micropuncture needle Ultrasound guidance Vascular access

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Area of Science:

Interventional Cardiology
Vascular Access Techniques

Background:

Interventional cardiology increasingly relies on complex percutaneous procedures.
Successful procedures often hinge on achieving safe, large-bore vascular access.
Challenges like arterial tortuosity and calcification can impede common femoral artery access.

Purpose of the Study:

To outline key techniques for successful percutaneous vascular access.
To discuss methods for achieving adequate hemostasis post-procedure.
To highlight the importance of recognizing and managing access-related complications.

Main Methods:

Utilizing knowledge of anatomic landmarks.
Employing ultrasound and fluoroscopy for guidance.
Implementing micropuncture techniques for initial access.
Using commercially available vascular closure devices for hemostasis.

Main Results:

Meticulous technique incorporating anatomical knowledge and imaging enhances procedural success.
Appropriate use of closure devices effectively achieves hemostasis.
Early recognition is vital for managing uncommon access-related vascular complications.

Conclusions:

Safe and effective large-bore vascular access is fundamental to advanced interventional cardiology.
A combination of technical skill, imaging, and closure devices optimizes patient outcomes.
Addressing challenges like arterial tortuosity is essential for widespread procedural applicability.