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Considerations in Choosing an Arterial Access Site

 Nick G. Cavros MD FAC
Description: Access is Everything: From Routine to Advanced in Peripheral Intervention: Choices for Access- Axillary, Brachial, Radial, Femoral, Popliteal, Pedal, digital. Considerations in Choosing Access Site: Target area(s), Procedural needs-Sheath size,Devices expected to be used, Clinical presentation-CLI vs claudication, Body habitus, Previous interventions/surgeries.Pre-procedural Work Up: Routine, BMP, Renal function, Imaging, Ultrasound, CTA. Femoral Access: Predominant mode of access-Familiar, Most equipment made to work through femoral access. Retrograde, Anterograde. Using Fluoroscopy-Excellent visualization of landmarks, Can often visualize Calcium. Catheters to engage contralateral iliac artery-RIM,OMNIFLUSH,MOTARJEME,LIMA. Retrograde Femoral Access-Engage contralateral iliac artery, Advance wire as far as possible, Switch for a crossover sheath. Iliac arteries. Anterograde Femoral Access: Advantages-Easy manipulation of devices,Below the knee intervention,Avoids tortuous iliac artery anatomy. Use micropuncture with fluoroscopic/ultrasound guidance, Shallow angle to avoid sheath kink.Antegrade Femoral Access: Disadvantages-Obese patients, hemostasis.Upper Extremity Arterial Access- Advantages- Aorto-iliac or ostial common iliac artery occlusion, Bilateral common femoral artery occlusion, Iliac bypass graft, Renal/Mesenteric Intervention, Patients on anticoagulation (Radial). Disadvantages- distance, Unable to deliver equipment past common femoral/mid SFA, Limited Sheath Size, Ulnar artery occlusion (Radial), LIMA graft occlusion, Hemostasis.Popliteal access- Advantage- Distal cap easier to cross, Long SFA occlusion, Ostial SFA occlusion. Disadvantages- Prone position, Suboptimal for disease extending into popliteal artery, Proximity of popliteal vein.Pedal Access-Essential part of a limb salvage program, Alternative access to treat challenging CTO’s, BTK, SFA. Access-Location- Dorsalis Pedis,Posterior Tibial, Peroneal. Methods of Access- Angiographic,Ultrasound guided. Angiographic-Inject dye from contralateral approach, Cannulate vessel under, direct fluoro guidance. Advantages-Comfort level,No need for ultrasound. Disadvantage- Radiation/Contrast, Inability to visualize the vessel in 3D plane, Patient movement.
Views: 1318
Domain: Medical
Category: Therapy
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Access is Everything:
From Routine to Advanced
in Peripheral Intervention

Nick G. Cavros, MD, FACC






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