Large Bore Access for the Interventional Cardiologist-Access

Video Transcription

Video Summary

This expert panel discussion, led by interventional cardiologists from various U.S. institutions, focuses on large-bore vascular access—a critical component in high-risk coronary and structural interventions. Key points include the importance of precise femoral artery access to avoid complications like retroperitoneal bleeding. Panelists emphasize multimodal imaging—pre-procedural CT, intra-procedural fluoroscopy, and ultrasound—to identify the optimal puncture site, especially avoiding arterial bifurcations and anterior wall calcifications. The use of micropuncture techniques is recommended to confirm safe access before upsizing to large sheaths. They discuss differing personal preferences in ultrasound imaging views (transverse vs. longitudinal) and timing for angiographic confirmation of sheath placement. Despite evolving technology, tactile skill and palpation remain valuable, especially when imaging is unavailable. Tips include avoiding soft tissue puncture in obese patients and gentle wire advancement to prevent kinking. The webinar advocates a comprehensive, safety-focused approach combining imaging, experience, and technique nuances to improve patient outcomes with large-bore femoral access.

Keywords

large-bore vascular access

femoral artery access

multimodal imaging

micropuncture technique

ultrasound imaging views

vascular access complications