Читать книгу Interventional Cardiology - Группа авторов - Страница 92

Mechanical circulatory support devices and transcatheter valve interventions both require large bore access. The “safe femoral” strategy has been proposed to reduce complications associated with TFA [54]. This approach comprises four steps. The first involves fluoroscopic landmark assessment to locate the inferior border of the femoral head as the correct location for skin puncture. Following this, an ultrasound probe is placed over the femoral head to visualize both the bifurcation of the common femoral artery, which should be inferior to the intended catheterization point, and any anterior calcification that should be avoided. Next, a micropuncture (21‐gauge) needle punctures the femoral artery under ultrasound guidance before advancement of an 0.018″ wire into the common iliac artery. A 4 Fr or 5 Fr sheath can then be deployed. Finally, at the end of the case, a vascular closure device is used to achieve hemostasis. Despite these steps to minimize complications, the radial approach remains the default as it is still safer [54].