Transfemoral Access for Large-Bore Interventions

Abstract

Interventions requiring large-bore access have been rapidly increasing in recent years with the dramatic growth of transcatheter aortic valve replacement (TAVR), use of adjunctive mechanical ventricular support systems, and expanded use of endovascular treatment of aortic disease. Typically these procedures require the use of sheaths ranging from 10 to 24 French in size. The common femoral artery can provide an appropriate access site for such procedures. Adequate anatomical characteristics of the common femoral and iliac arteries can be determined by angiography. Complete percutaneous access and closure are possible with the use of a careful technique and appropriate devices. A preclosure technique is commonly used to secure sutures in the common femoral artery prior to upsizing the arteriotomy. Operators should be prepared to manage potential complications.