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CIRSE Standards of Practice on Arterial Access for Interventions


This CIRSE Standards of Practice document is aimed at healthcare professionals (including interventional radiologists) performing endovascular procedures to provide best practices for performing arterial access for interventions. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. This paper encompasses up-to-date clinical and technical aspects in performing safe and appropriate arterial access for interventions.

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Magnetic resonance angiography


General practitioner


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  1. Lu JT, Creager MA. The relationship of cigarette smoking to peripheral arterial disease. Rev Cardiovasc Med. 2004;5(4):189–93.

    PubMed  Google Scholar 

  2. Peripheral arterial disease: diagnosis and management clinical guideline. (2012). [online]. Available at:

  3. Vartanian SM, Conte MS. Surgical intervention for peripheral arterial disease. Circ Res. 2015;116(9):1614–28.

    Article  CAS  PubMed  Google Scholar 

  4. Thukkani AK, Kinlay S. Endovascular intervention for peripheral artery disease. Circ Res. 2015;116(9):1599–613.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Spiliopoulos S, et al. Day-case treatment of peripheral arterial disease: results from a multi-center European study. Cardiovasc Intervent Radiol. 2016;39(12):1684–91.

    Article  PubMed  Google Scholar 

  6. Guez D, et al. Recent trends in endovascular and surgical treatment of peripheral arterial disease in the medicare population. AJR Am J Roentgenol. 2020;214(5):962–6.

    Article  PubMed  Google Scholar 

  7. Seto AH, Abu-Fadel MS, Sparling JM, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (femoral arterial access with ultrasound trial). JACC Cardiovasc Interv. 2010;3(7):751–8.

    Article  PubMed  Google Scholar 

  8. Hadi M, Walker C, Desborough M, et al. CIRSE standards of practice on peri-operative anticoagulation management during interventional radiology procedures. Cardiovasc Intervent Radiol. 2021;44:523–36.

    Article  PubMed  Google Scholar 

  9. Cable DG, et al. The allen test. Ann Thorac Surg. 1999;67(3):876–7.

    Article  CAS  PubMed  Google Scholar 

  10. Jarvis MA, et al. Reliability of allen’s test in selection of patients for radial artery harvest. Ann Thorac Surg. 2000;70(4):1362–5.

    Article  CAS  PubMed  Google Scholar 

  11. Barbeau GR, Arsenault F, Dugas L, Simard S, Larivière MM. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: Comparison with the allen’s test in 1010 patients. Am Heart J. 2004;147(3):489–93.

    Article  PubMed  Google Scholar 

  12. Dhanoa D, et al. Position statement on noninvasive imaging of peripheral arterial disease by the society of interventional radiology and the Canadian interventional radiology association. J Vasc Interv Radiol. 2016;27(7):947–51.

    Article  PubMed  Google Scholar 

  13. Christie A, Roditi G. Vascular imaging: the evolving role of the multidisciplinary team meeting in peripheral vascular disease. Semin Intervent Radiol. 2014;31(4):320–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Layden J, Michaels J, Bermingham S, Higgins B; Guideline Development Group. Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance. BMJ. 2012;345:e4947.

  15. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American association for vascular surgery/society for vascular surgery; society for cardiovascular angiography and interventions; society for vascular medicine and biology; society of interventional radiology; ACC/AHA task force on practice guidelines. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American associations for vascular surgery/society for vascular surgery, society for cardiovascular angiography and interventions, society for vascular medicine and biology, society of interventional radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)--summary of recommendations. J Vasc Interv Radiol. 2006;17(9):1383–97.

  16. Lee MJ, Fanelli F, Haage P, Hausegger K, Van Lienden KP. Patient safety in interventional radiology: a CIRSE IR checklist. Cardiovasc Intervent Radiol. 2012;35(2):244–6.

    Article  CAS  PubMed  Google Scholar 

  17. Golfieri R, Pescarini L, Fileni A, Silverio R, Saccavini C, Visconti D, Morana G, Centonze M. Clinical risk management in radiology. Part I: general background and types of error and their prevention. Radiol Med. 2010;115(7):1121–46.

    Article  CAS  PubMed  Google Scholar 

  18. Corso R, Vacirca F, Patelli C, Leni D. Use of “time-out” checklist in interventional radiology procedures as a tool to enhance patient safety. Radiol Med. 2014;119(11):828–34.

    Article  PubMed  Google Scholar 

  19. Dankelman J, Grimbergen CA. Systems approach to reduce errors in surgery. Surg Endosc. 2005;19(8):1017–21.

    Article  CAS  PubMed  Google Scholar 

  20. Koetser IC, de Vries EN, van Delden OM, Smorenburg SM, Boermeester MA, van Lienden KP. A checklist to improve patient safety in interventional radiology. Cardiovasc Intervent Radiol. 2013;36(2):312–9.

    Article  PubMed  Google Scholar 

  21. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol. 1953;39(5):368–76.

    Article  CAS  PubMed  Google Scholar 

  22. Kemper FJ, Tielbeek AV, el Biltagiu S, el Gamal MI, van Gelder LM. Shearing of the plastic coating of a hydrophilic guide wire in a right femoropopliteal bypass graft: removal from the contralateral side. Cathet Cardiovasc Diagn. 1992;27(3):209–11.

    Article  CAS  PubMed  Google Scholar 

  23. Rogers RK, Dattilo PB, Garcia JA, Tsai T, Casserly IP. Retrograde approach to recanalization of complex tibial disease. Catheter Cardiovasc Interv. 2011;77(6):915–25.

    Article  PubMed  Google Scholar 

  24. Goldsweig AM, Secemsky EA. Vascular Access and Closure for Peripheral Arterial Intervention. Interv Cardiol Clin. 2020;9(2):117–24.

    PubMed  Google Scholar 

  25. Robertson L, Andras A, Colgan F, Jackson R. Vascular closure devices for femoral arterial puncture site haemostasis. Cochrane Database Syst Rev. 2016;3:CD009541.

    PubMed  Google Scholar 

  26. Chehab MA, Thakor AS, Tulin-Silver S, Connolly BL, Cahill AM, Ward TJ, Padia SA, Kohi MP, Midia M, Chaudry G, Gemmete JJ, Mitchell JW, Brody L, Crowley JJ, Heran MKS, Weinstein JL, Nikolic B, Dariushnia SR, Tam AL, Venkatesan AM. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a society of interventional radiology practice parameter update endorsed by the cardiovascular and interventional radiological society of Europe and the canadian association for interventional radiology. J Vasc Interv Radiol. 2018;29(11):1483-1501.e2.

    Article  PubMed  Google Scholar 

  27. Slattery MM, Goh GS, Power S, Given MF, McGrath FP, Lee MJ. Comparison of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery puncture techniques. Cardiovasc Intervent Radiol. 2015;38(3):579–82.

    Article  PubMed  Google Scholar 

  28. Moussa Pacha H, Alahdab F, Al-Khadra Y, Idris A, Rabbat F, Darmoch F, Soud M, Zaitoun A, Kaki A, Rao SV, Kwok CS, Mamas MA, Alraies MC. Ultrasound-guided versus palpation-guided radial artery catheterization in adult population: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2018;204:1–8.

    Article  PubMed  Google Scholar 

  29. Nairoukh Z, Jahangir S, Adjepong D, Malik BH. Distal radial artery access: the future of cardiovascular intervention. Cureus. 2020;12(3): e7201.

    PubMed  PubMed Central  Google Scholar 

  30. Kaufman JA, Lee MJ. Vascular and interventional radiology: the requisites E-Book: Elsevier Health Sciences; 2013.

  31. Schmidt A, Scheinert D. Transpedal access. Catheter-Based Cardiovascular Interventions: Springer; 2013. p. 413–22.

    Google Scholar 

  32. Schug SA, Fuller C, Lau JH. Local anesthetics. Side effects of drugs annual. 31: Elsevier; 2009. p. 231–45.

  33. Pate G, Broderick B. Variations in the usage and composition of a radial cocktail during radial access coronary angiography procedures. Ir Med J. 2011;104(9):280–1.

    CAS  PubMed  Google Scholar 

  34. Noori VJ, Eldrup-Jørgensen J. A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg. 2018;68(3):887–99.

    Article  PubMed  Google Scholar 

  35. Van Wiechen MP, Ligthart JM, Van Mieghem NM. Large-bore vascular closure: new devices and techniques. Interv Cardiol. 2019;14(1):17–21.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tagliaferro FB, Orgera G, Mascagni L, Laurino F, Tipaldi MA, Cariati M, Rossi M. FemoSeal® vascular closure device for antegrade common femoral artery access: Safety and technical notes. J Vasc Access. 2020;21(1):79–85.

    Article  PubMed  Google Scholar 

  37. Spiliopoulos S, Karnabatidis D, Katsanos K, et al. Day-case treatment of peripheral arterial disease: results from a multi-center european study. Cardiovasc Intervent Radiol. 2016;39(12):1684–91.

    Article  PubMed  Google Scholar 

  38. Upponi SS, Ganeshan AG, Warakaulle DR, et al. Angioseal versus manual compression for haemostasis following peripheral vascular diagnostic and interventional procedures—a randomized controlled trial. Eur J Radiol. 2007;61(2):332–4.

    Article  CAS  PubMed  Google Scholar 

  39. Samal AK, White CJ. Percutaneous management of access site complications. Catheter Cardiovasc Interv. 2002;57:12–23.

    Article  PubMed  Google Scholar 

  40. Kuchulakanti PK, Satler LF, Suddath WO, et al. Vascular complications following coronary intervention correlate with long-term cardiac events. Catheter Cardiovasc Interv. 2004;62:181–5.

    Article  PubMed  Google Scholar 

  41. Tsetis D. Endovascular treatment of complications of femoral arterial access. Cardiovasc Intervent Radiol. 2010;33:457–68.

    Article  PubMed  Google Scholar 

  42. Tavris DR, Wang Y, Jacobs S, et al. Bleeding and vascular complications at the femoral access site following percutaneous coronary intervention (PCI): an evaluation of hemostasis strategies. J Invasive Cardiol. 2012;24:328–34.

    PubMed  Google Scholar 

  43. Tsetis DK, Perdikakis E, Kehagias E. Percutaneous treatment of iatrogenic femoral artery access complications. Hell J Radiol. 2017;2(2):51–65.

    Google Scholar 

  44. Harris E, Warner CJ, Hnath JC, Sternbach Y, Clement Darling III, R. Percutaneous axillary artery access for endovascular interventions. Journal of Vascular Surg. 2018;68:555–9.

    Article  Google Scholar 

  45. Radaideh Q, Shammas NW. When pedal access is the only way to save a limb! Int J Angiol. 2020;29(3):205–9.

    Article  PubMed  Google Scholar 

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This study was not supported by any funding.

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Correspondence to Elika Kashef.

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Dr. Gerard O’Sullivan is a paid consultant for Bard BD, Boston Scientific, Cook Medical, Creagh Medical, Creganna Medical, Marvao Medical, Medtronic, Orthosensor and Vetex Medical. Dr. Elika Kashef is a paid consultant for Guerbet, Boston Scientific and Medtronic. All other authors declare they have no conflict of interest.

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Memarian, S., Krokidis, M., O’Sullivan, G. et al. CIRSE Standards of Practice on Arterial Access for Interventions. Cardiovasc Intervent Radiol 46, 302–309 (2023).

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  • Clinical practice
  • Arterial intervention