Managing and Troubleshooting Femoral Access and Closure with Dr. Raj Patel

July 24, 2019

Femoral Access and Closure Strategies and Best Practices

Rajan Patel, MD, FACC, FAHA, FSCAI, interventional cardiologist at Ochsner Clinic, presents a series of case studies highlighting management and troubleshooting techniques for femoral artery access and closure.

Dr. Patel emphasizes that “getting access is technique dependent, not technology dependent.” To illustrate access strategies, he presents a patient with aorto-iliac disease who underwent protected PCI. He describes the benefits of using a long sheath in long segment iliac disease. He also highlights the best practice of perfusion confirmation, particularly in a prolonged protected PCI case in which the patient has significant peripheral arterial disease. This practice can identify bleeding while the patient is still in the cath lab where the equipment for bleeding management is readily available. Dr. Patel also discusses rapid execution of balloon tamponade as well as 5-minute balloon inflation to resolve bleeding concerns.

Using another case, Dr. Patel emphasizes the importance of not causing vascular trauma when placing a large sheath through a diseased vessel. He recommends balloon dilation to allow passage of the sheath to perform multivessel PCI followed by stenting at the end of the case and a final angiogram after removing the sheath and cinching Percloses (Perclose ProGlide® SMC System, Abbott Vascular). In a case with CFA calcification, Dr. Patel mentions using an alternative closure device, such as a Manta™ (Teleflex) plug device, and he also discusses using balloon tamponade or placing a VIABAHN® (Gore) stent. In a case where bleeding persisted after three 5-minute balloon inflations, he explains how he placed a VIABAHN® covered stent to help seal the bleeding segment.

Finally, Dr. Patel reviews a case of pseudoaneurysm 3 days after Impella® (Abiomed) removal, describing how this case was successfully managed using low pressure balloon inflation over the neck of the pseudoaneurysm. He explains how the balloon aids in preventing thrombin from extravasating into the main vessel when thrombin is injected into the pseudoaneurysm.

Underlying all the femoral access and closure strategies Dr. Patel discusses is the theme “skills matter.” Develop placement skills and also develop skills for managing complications and improving patient outcomes.

 

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