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Updated: Nov 12, 2025

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
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.
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.

