Contemporary Techniques for Femoral and Radial Arterial Access in the Cardiac Catheterization Laboratory
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Published on: April 1, 2022
James D Gladden1, Rajiv Gulati1, Yader Sandoval1
1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Transradial access is now standard for many cardiac procedures due to its safety and patient comfort. Transfemoral access remains essential for complex interventions and large-bore device placements.
Area of Science:
- Cardiology
- Vascular Access Techniques
Background:
- Safe and efficient arterial access is crucial for patient outcomes in cardiac catheterization.
- Transradial access is increasingly preferred for diagnostic angiography and percutaneous coronary intervention due to reduced complications and improved patient comfort.
- Transfemoral access is still necessary for complex percutaneous coronary interventions, mechanical circulatory support, and structural heart procedures.
Purpose of the Study:
- To review contemporary techniques for femoral and radial arterial access in the cardiac catheterization laboratory.
- To highlight the importance of optimal access techniques, especially with the rise of structural heart and mechanical circulatory support procedures.
Main Methods:
- Review of current literature and practices for arterial access in cardiac catheterization.
- Discussion of adjunctive technologies and techniques, including ultrasound guidance and micropuncture, used with fluoroscopy and palpation.
Main Results:
- Transradial access is the predominant approach for diagnostic coronary angiography and percutaneous coronary intervention.
- Transfemoral access is indicated for specific complex procedures and large-bore sheath interventions.
- Ultrasound guidance and micropuncture techniques can enhance vascular access outcomes.
Conclusions:
- Optimal arterial access techniques are vital for procedural success and patient safety.
- The choice between transradial and transfemoral access depends on the specific procedure and patient factors.
- Advancements in technology and technique continue to improve vascular access in cardiac catheterization.
Abstract:
Safe and efficient arterial access is critical for optimal patient outcomes and procedural success in the cardiac catheterization laboratory. Because of the lower risk for vascular and bleeding complications, as well as patient comfort, transradial access has become the predominant approach for diagnostic coronary angiography and percutaneous coronary intervention. Transfemoral access, however, is still required for selected complex percutaneous coronary interventions, mechanical circulatory support, and structural heart procedures. The use of adjunctive technology and techniques such as ultrasound guidance and micropuncture can be combined with fluoroscopy and palpation to improve outcomes associated with vascular access. The importance of optimal access techniques has augmented due to increasing volume of structural heart and mechanical circulatory support procedures requiring large bore sheaths. In this document we review the contemporary techniques for femoral and radial access in the cardiac catheterization laboratory.
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