Femoral and brachial artery access

Abstract

The selection of vascular access site is the first critical decision to be made when planning any endovascular procedure. The choice of access site is influenced by patient and procedural considerations, with the operator seeking to balance the benefits and risks unique to each access site. This chapter reviews transfemoral and transbrachial vascular access, two principle access sites used widely for endovascular therapies. Optimizing technique of access for any site has been shown to reduce the frequency of access site complications, which remain among the most common and serious adverse events following endovascular interventions. Use of consistent and meticulous access techniques as well as routine angiography of the femoral access site is recommended. Common vascular access site complications are reviewed, including access site bleeding, compromise of vessel wall integrity, and compromise of perfusion due to dissection or embolization. Unique anatomical considerations of brachial artery access that increase the potential for complications are reviewed, and recommendations for minimizing risks for this access site are provided.