Large-Bore Transfemoral Arterial Access: Techniques and Troubleshooting

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Historically, open surgical repair was the standard for aortic pathologies like dissection and aneurysm.
• Endovascular aortic repair (EVAR) using stent grafts has become a viable alternative for more patients.
• EVAR often necessitates large-bore transfemoral arterial access for device deployment.

Purpose of the Study:

• To review the fundamentals of large-bore transfemoral arterial access for EVAR.
• To provide technical pearls for successful outcomes in percutaneous transfemoral arterial access.
• To highlight advancements in closure techniques and device delivery profiles.

Main Methods:

• Review of current literature and clinical practices regarding transfemoral arterial access.
• Discussion of preprocedural planning considerations for large-bore access.
• Description of technical aspects and potential complications of the procedure.

Main Results:

• Improvements in stent graft technology and delivery systems expand EVAR candidacy.
• Percutaneous transfemoral access involves direct introduction of large sheaths into the iliofemoral arteries.
• Advancements in closure devices and reduced profiles enhance technique safety and efficacy.

Conclusions:

• Large-bore transfemoral arterial access is essential for modern endovascular aortic repair.
• Meticulous preprocedural planning and precise technique are paramount to reduce complications.
• Continued refinement of devices and techniques improves patient outcomes in EVAR.