Access Techniques

Abstract

Safe performance of abdominal and thoracic endovascular procedures requires zero tolerance for major access-related complications. Thorough preoperative planning, understanding the pathology of aortoiliac occlusive disease, advanced endovascular skills, percutaneous femoral and brachial techniques, open femoral techniques, and ability to construct an iliac conduit via a retroperitoneal approach and deployment of an endoconduit are necessary to achieve excellent results. When choosing which site to access the vascular tree, one must not only consider the intended procedure but also the size of the sheath and distance to the pathology. Sheaths up to 12 French (F) (4 mm) can be safely placed with a percutaneous approach. Larger sheaths most commonly require a femoral cut-down or, less commonly, a subclavian access to ensure vascular hemostasis and minimize traumatic injury to the access vessel. If the physician is not adaptive to utilizing alternative access sites, then the procedure will be compromised. A totally percutaneous approach is also possible using large sheaths using the pre-close technique with the Prostar device (Abbott Laboratories; Abbott Park, IL).