Vascular access: evolving from femoral to distal radial artery

Introduction

Radial artery represents the primary vascular access site in many countries. Yet, common femoral artery still remains necessary not just as a bailout vascular access but also for procedures requiring large-bore catheters or devices. Trans-femoral approach is in fact the default access for trans-catheter aortic valve implantation (TAVI) 11. Webb JG, Wood DA. Current status of transcatheter aortic valve replacement. Journal of the American College of Cardiology. 2012;60:483-92. Link, and it might also be required in cases of mechanical circulatory support, i.e. in the setting of cardiogenic shock or during high risk PCI when performed with intra-aortic balloon pump (IABP), Impella (Abiomed, Danvers, Massachusetts), or veno-arterial extracorporeal membrane oxygenation (ECMO) 22. Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. European heart journal. 2014;35:156-67. Link. In addition, femoral access is still the preferred access site for some complex coronary interventions, such as in PCI of coronary chronic total occlusion 3, 43. Alaswad K, Menon RV, Christopoulos G, Lombardi WL, Karmpaliotis D, Grantham JA, Marso SP, Wyman MR, Pokala NR, Patel SM, Kotsia AP, Rangan BV, Lembo N, Kandzari D, Lee J, Kalynych A, Carlson H, Garcia...