Vascular Access: Arterial, Venous, and Ultrasound Guidance

  • Punit S. Parasher
  • Andrew J. Boyle


In this section, we will outline clinical pointers, tips, and “how we do it” in regards to obtaining access in the femoral, radial, brachial, and popliteal arteries and vascular grafts.


Radial Artery Popliteal Artery Superficial Femoral Artery Chronic Total Occlusion Femoral Artery Puncture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hessel SJ, Adams DS, Avrams HL: Complications of angiography. Radiology 1981; 138:273–281PubMedGoogle Scholar
  2. 2.
    Illescas FF, Baker ME, McCann, et al: CT evaluation of retroperitoneal hemorrhage associated with femoral arteriography. AJR 1996;146:1289–1292. Æ This was a case series of six patients that examined the factors that predispose to bleeding complications during femoral arterial puncture and provides clues and techniques to diagnose retroperitoneal hematomas rapidly.Google Scholar
  3. 3.
    Altin RS, Flicker S, Naidech HJ: Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: Association with lower femoral punctures. AJR 1989; 152:629–631. Æ This retrospective study included 11 patients who had undergone cardiac catheterization with subsequent development of a pseudoaneurysm or AVF and through femoral arteriography it was determined that the overwhelming majority of these complications resulted when the site of the femoral artery puncture was below the level of the femoral head. PubMedGoogle Scholar
  4. 4.
    Grier D, Hartnell G. Percutaneous femoral artery puncture: Practice and Anatomy. Br J Radiol 1990; 63:602–604. Æ This paper compared operator preference for femoral arterial puncture (inguinal crease vs. maximal femoral pulse vs. fluoroscopy guided) and found that the most accurate predictor of CFA puncture was use of the maximal femoral pulse to guide the arterial puncture. PubMedCrossRefGoogle Scholar
  5. 5.
    Rupp SB, Vegelzang RI, Nemcek AA, et al: Relationship of the inguinal ligament to pelvic radiographic landmarks: Anatomic correlation and its role in femoral arteriography. JVIR 1993;4:409–413. Æ This was a case series of ten cadavers that underwent radiographic and manual determination of the inguinal ligament, followed by dissection and inspection of the gross ­anatomical specimen to determine accuracy, with results showing that the midportion of the femoral head will most often provide the best anatomical landmark for puncture of the CFA. PubMedCrossRefGoogle Scholar
  6. 6.
    Criado FJ, Twena M, Halsted M, Abul-Khoudoud, O: Percutaneous femoral puncture for endovascular treatment of arterial occlusive lesions. Am J Surg 1998;176:119–121.PubMedCrossRefGoogle Scholar
  7. 7.
    Khoury M, Batra S, Berg R, et al. Influence of arterial access sites and interventional procedures on vascular complications after cardiac catheterizations. Am J Surg 1992;164(3):205–209.PubMedCrossRefGoogle Scholar
  8. 8.
    Kiemeneij F, Laarman GJ, Odekerken D, et al. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study. J Am Coll Cardiol 1997;29(6):1269–1275. Æ This was a randomized comparison between transradial, transbrachial, and transfemoral approaches to PTCA with primary endpoints being access site difficulty (requiring the need for an alternative access site) and access-site complications, which found that vascular complications were significantly more frequent after transbrachial and transfemoral approaches. PubMedCrossRefGoogle Scholar
  9. 9.
    Grossman M: How to miss the profunda femoris. Radiology 125:379–382, 1977.Google Scholar
  10. 10.
    Agostoni P, Biondi-Zoccai GG, de Benedictis ML et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol 2004; 44(2): 349–56. Æ This is a meta-analysis of 12 randomized trials examining procedural complications related to transradial vs. transfemoral approaches for vascular access and demonstrates significant decrease in local vascular complications with transradial vascular access. PubMedCrossRefGoogle Scholar
  11. 11.
    Kiemeneij F, Fraser D, Slagboom T, Laarman G, van der Wieken R. Hydrophilic coating aids radial sheath withdrawal and reduces patient discomfort following transradial coronary intervention: a randomized doubleblind comparison of coated and uncoated sheaths. Catheter Cardiovasc Interv 2003; 59(2): 161–4. Æ This is a double-blind randomized comparison of hydrophilic-coated or uncoated sheaths in preventing radial artery spasm following transradial access, but also demonstrates that use of a vasodilator cocktail after sheath placement reduces the incidence of radial artery spasm. PubMedCrossRefGoogle Scholar
  12. 12.
    Barbeau GR, Arsenault F, Dugas L, Simard S, Lariviere 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; 147:489–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Ghuran A, Dixon G, Holmberg S, et al. Transradial coronary intervention without prescreening for a dual palmar blood supply. Int J Cardiol 2007;121:320–322.PubMedCrossRefGoogle Scholar
  14. 14.
    Rhyne D and Mann, T. Hand ischemia resulting from a transradial intervention: Successful management with radial artery angioplasty. Cath and Cardiovasc Interv 2010;76:383–386. Æ This is a case report describing a patient who developed radial occlusion leading to hand ischemia following transradial access despite having a pre-procedural plethysmograph showing dual blood supply. CrossRefGoogle Scholar
  15. 15.
    Kamada RO, Fergusson DJ, Itagaki RK. Percutaneous entry of the brachial artery for transluminal coronary angioplasty. Cathet Cardiovasc Diagn 1988;15:132–133.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Cardiology, Department of MedicineUniversity of California – San FranciscoSan FranciscoUSA

Personalised recommendations