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Obtaining femoral and radial arterial access in the cardiac catheterization laboratory using state-of-the-art techniques is essential to optimize outcomes, patient satisfaction, and procedural efficiency. Although transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, femoral access remains necessary for numerous procedures, many requiring large-bore access, including complex high-risk coronary interventions, structural procedures, and procedures involving mechanical circulatory support. For femoral access, contemporary access techniques should combine the use of fluoroscopy, ultrasound, micropuncture needle, femoral angiography, and vascular closure devices, when feasible. For radial access, ultrasound may reveal important anatomic features and expedite access. Despite randomized controlled trials supporting use of routine ultrasound guidance for femoral and/or radial arterial access, ultrasound remains underused in cardiac catheterization laboratories. This article reviews contemporary techniques to achieve optimal arterial access in the cardiac catheterization laboratory. [ABSTRACT FROM AUTHOR]

Vascular interventionalists continue to expand the scope and breadth of endovascular procedures that we offer to our patients. However, we often have to overcome various anatomical and technical challenges to deliver an endovascular device. This article should give the modern interventionalist an array of technical tips and tricks to enable them to overcome various challenging anatomical features such as vessel tortuosity, vascular calcifications, and increasing abdominal pannus. We also hope to elucidate alternative accesses such as radial access, pedal access, popliteal access, and direct stent access as well as direct aortic access. [ABSTRACT FROM AUTHOR]

Although common femoral arterial access remains the cornerstone for endovascular interventions, alternative arterial access sites such as the brachial, axillary, and popliteal arteries as well as surgical bypass grafts offer additional options when the conventional approach is unavailable or impractical. Each of these alternative access sites features a unique blend of risks and benefits, and the interventionalist should be well versed not only in how to safely enter the arterial system at these locations but also in how to safely exit. Manual compression represents the gold standard method for hemostasis at all vascular access sites, though variations and modifications in the technique exist based on anatomical factors in different arteries. Vascular closure devices widely used for common femoral arteriotomy closure have also been applied in “off-label” settings for multiple additional arteries. In this article, we discuss the pertinent anatomy as well as summarize the literature and anecdotal experience regarding methods for achieving hemostasis at multiple alternative arterial access sites. [ABSTRACT FROM AUTHOR]

Abstract: Access site complication rates remain relatively high following interventional procedures and have not been shown to be reduced by the use of vascular closure devices. This report describes an ultrasound-assisted technique of deploying one type of vascular closure device, the StarClose (Abbott Vascular, Illinois, USA). This technique has significantly reduced failure rates and complication rates since its introduction. The technique is relatively simple but requires familiarity with the use of ultrasound and the StarClose device. [Copyright &y& Elsevier]

Abstract: The only absolute indication for the placement of an arterial line is during cardiopulmonary bypass, when the lack of pulsatile blood flow makes the measurement of blood pressure impossible. However, arterial lines are useful whenever beat-to-beat blood pressure monitoring or frequent sampling of arterial blood is indicated. This includes situations such as sepsis, shock, hypertensive crisis, respiratory compromise, prolonged ventilator weans, and other conditions where the use of vasoactive drugs is required. Arterial lines may also aid in the assessment of cardiac contractility by examination of the shape of the waveform and upstroke of the tracing, or as a requisite portion of some techniques for the minimally invasive assessment of cardiac output. [Copyright &y& Elsevier]