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J Interv Cardiol. 2018 Dec;31(6):969-977. doi: 10.1111/joic.12571. Epub 2018 Nov 19.

Access and closure management of large bore femoral arterial access.

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Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan.
Zucker School of Medicine at Hofstra Northwell Health, Northshore University Hospital, Manhasset, New York.
University of Michigan, Ann Arbor, Michigan.
Northwell Health, Lenox Hill Hospital, New York, New York.


Femoral and radial artery access continue to be the standard of care for percutaneous coronary interventions. Cardiac catheterization has progressed to encompass a wide range of diagnostic and interventional procedures including coronary, peripheral, endovascular, and structural heart disease interventions. Despite advanced technology to make these procedures safe, bleeding, and vascular complications continue to be a substantial source of morbidity, especially in patients undergoing large-bore access procedures. New variations of percutaneous devices have reduced complications associated with these procedures. However, safe vascular access with effective hemostasis requires special techniques which have not been well described in the literature. Large-bore femoral artery access is feasible, safe, and associated with low complication rates when a protocol is implemented. Wayne State University, Detroit Medical Center Heart Hospital is a tertiary care, high-volume center for endovascular, structural heart and complex high risk indicated procedures with more 150 procedures involving mechanical circulatory support (MCS) devices per year. In this manuscript, we describe our approach to femoral artery large-bore sheath insertion and management. Our protocol includes proper identification of the puncture site, device selection, insertion, assessment of limb perfusion while on prolong MCS support, and hemostasis techniques after sheath removal.


complex coronary intervention; coronary artery disease; femoral closure devices; interventional devices; large femoral access; structural heart disease

[Indexed for MEDLINE]

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