Vascular access

Summary

Vascular access is the first technical part of any percutaneous cardiovascular procedure and can determine its overall success. In the pioneer era of coronary angiography and intervention, brachial arteriotomy was the first technique to be used routinely. The advent of pre-shaped Judkins catheters designed for a percutaneous femoral arterial approach saw a shift to access using the lower limb. More recently there has been a resurgence of interest for upper limb access with the development and establishment of the transradial approach as the default technique for coronary procedures and refinement of transfemoral access for transcatheter structural procedures. A dramatic reduction in access site related haemorrhagic complications and earlier patient mobilisation have been significant drivers for this new approach, however, for coronary procedures there is no clear superiority of one access site over another in terms of hard clinical endpoints. Venous access for right heart catheterisation has traditionally been performed via the femoral approach, although an upper limb approach is feasible Structural cardiovascular procedures via the femoral approach have also seen a resurgence.

A mixture of patient-related, anatomical and technical factors may influence the choice of vascular access. Key considerations for all percutaneous approaches are the Seldinger and adjunctive imaging...