Large Sheath Management in Patients with Poor Peripheral Access

Despite the evolution of device technology and increasing operator experience, vascular and bleeding complications remain a major source of perioperative morbidity and mortality, particularly in patients with peripheral arterial disease. These complications may be compounded with the use of large bore access sheaths for mechanical support, which may be required to be left in the vessels for a prolonged period of time. Through this article, the authors demonstrate the importance of assessment for peripheral arterial disease before insertion of large bore sheaths. They also describe various strategies to manage occlusive sheaths for distal reperfusion and percutaneous axillary artery access as an alternate option.