Large Bore Access for the Interventional Cardiologist-Maintenance

Video Transcription

Video Summary

In this comprehensive discussion, interventional cardiologists Dr. Mukherjee, Dr. Patel, Dr. Jayanna, and Dr. Ferreira address large-bore arterial access challenges and management strategies. Key points include vascular access techniques, complication mitigation, and closure methods. Emphasis was placed on maintaining limb perfusion during mechanical circulatory support, highlighting techniques like external contralateral and ipsilateral bypass circuits and pedal artery retrograde access, which help prevent limb ischemia—a critical risk with femoral artery occlusion.<br /><br />Complications such as bleeding, limb ischemia, vessel injury, and embolic events were discussed alongside their mitigation strategies, including ultrasound-guided access, appropriate anticoagulation, and early detection through Doppler and duplex studies. Proper device positioning, securing during patient transport, and team-based multidisciplinary care were underscored to prevent adverse outcomes.<br /><br />Alternative vascular access sites like the axillary artery were noted, with surgical options reserved for complex cases. Closure techniques primarily involve preclosure with Perclose sutures, supplemented by devices like Manta or Angio-Seal, and surgical repair if necessary.<br /><br />Overall, the panel advocated for a protocolized approach tailored to patient anatomy and device type, careful hemodynamic monitoring, and limb perfusion assessment to improve safety in large-bore access interventions increasingly used in critical cardiac care.

Keywords

large-bore arterial access

vascular access techniques

limb ischemia prevention

mechanical circulatory support

complication mitigation

closure methods

multidisciplinary care