Management of femoral large-bore access and closure during microaxial flow pump-supported interventions

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Devices

Background:

• Microaxial flow pumps (mAFP) are vital for hemodynamic support in cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCI).
• Large-bore arterial access required for mAFP implantation poses significant risks of vascular complications, increasing morbidity, mortality, and healthcare costs.
• Effective vascular access and closure strategies are essential for optimizing patient outcomes.

Purpose of the Study:

• To provide a contemporary, practical framework for managing femoral large-bore access and closure in patients undergoing mAFP implantation.
• To highlight the importance of imaging guidance and tailored closure techniques based on clinical scenarios (CS vs. HR-PCI).

Main Methods:

• Review of current literature and clinical practices regarding femoral access and closure in mAFP procedures.
• Discussion of imaging modalities (ultrasound, angiography) for safe puncture.
• Analysis of pre-closure versus post-closure techniques in different patient populations.

Main Results:

• Ultrasound- and angiography-guided puncture, with advanced imaging, improves femoral access safety.
• Pre-closure techniques are recommended prophylactically in the HR-PCI setting.
• Post-closure techniques are critical during mAFP removal in CS patients when pre-closure is not feasible.

Conclusions:

• Optimizing mAFP outcomes necessitates meticulous management of femoral large-bore access and closure.
• Tailoring closure strategies to patient conditions (CS vs. HR-PCI) is paramount for minimizing vascular complications.
• This review offers a practical guide for clinicians managing these complex vascular access scenarios.