Читать книгу Interventional Cardiology - Группа авторов - Страница 66

Proper management of femoral access is vital in reducing the femoral vascular adverse events, which are the most common complications in cardiac catheterizations and interventions. Refinements in antithrombotic and antiplatelet regimens, and reductions in access size have reduced ambulation times and the risks of complications. Vascular closure devices have further significantly improved hemostasis and ambulation times, and current data suggest they are mostly safe. However, there is no unequivocal evidence to suggest they reduce vascular complications in either diagnostic or interventional subgroups. Experience and expertise with whichever technique for femoral access site management one chooses are the best ways to minimize complications.

Just as important as management of vascular closure, careful attention to obtaining vascular access is important. Careful assessment of bony landmarks by fluoroscopy prior to femoral access will maximize the chance of sheath insertion into the common femoral artery with reductions in complications. Similarly, routine femoral angiography after femoral access to confirm sheath position is useful not only for assessing suitability of applications of vascular closure device, but also for assessing the risks of bleeding with use of antithrombotics which can affect interventional decision making. Femoral vascular access and closure approaches have been greatly refined by the demands of TAVR, with CT assessment for procedure planning, the use of micropuncture and ultrasound, and crossover techniques.