Sites of Arterial Access and the Role of Closure Devices in Percutaneous Arterial Intervention
Arterial access is the essential first step for all arterial vascular interventions. This chapter reviews the range of sites of arterial access and discusses the merits of each. Selecting the appropriate access route may be crucial to the success of the procedure. Operators need to be aware of the options available and the potential risks involved. The common femoral artery is the standard access site because it is a large vessel which is readily accessible and has the hard bony surface of the femoral head posteriorly to facilitate haemostasis by manual compression. Alternative access via various upper and lower limb sites are sometimes useful. The arterial puncture is the most common source of complications of arterial intervention. Indeed retroperitoneal haemorrhage particularly after antegrade femoral puncture is clinically difficult to detect and can be fatal. Management of the puncture site after the procedure is crucial to patient safety. The range of arterial closure devices is discussed along with the evidence for their effectiveness and complications. The use of closure devices is compared to haemostasis by manual compression in terms of the complications associated with each technique and the evidence for safe early mobilisation.
KeywordsFemoral Head Puncture Site Superficial Femoral Artery Common Femoral Artery Closure Device
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