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Shon Chakrabarti here with ProtectedPCI.com. I'm here to welcome Dr. Alex Truesdell who's visiting us from Virginia Heart and the INOVA Heart and Vascular Institute. Alex is going to talk to us today about safe access and closure focusing on his top three tips. Please Alex, we're excited to learn what you feel are the three most important things when it comes to access.
Great. Thank you very much. I appreciate you having me.
Obviously there's a lot of steps involved in vascular access and closure to make them safe. Really I think you can break it down to three key points.
One thing I always like to say is everyone wants to eat, but no one wants to cook and no one wants to clean up. I think that applies to vascular access and closure. Everybody wants to focus on the index coronary or cardiac procedure, but often less attention is paid to the steps of gaining access and closure afterwards. I think just keeping that in mind, that tip overarching everything else is by far the most important.
The second thing I would say is that you really have to use all of your senses when you're performing vascular access. You need your tactile sensation, utilization of anatomic landmarks, fluoroscopy, ultrasound and angiography altogether. You really want to become facile particularly in ultrasound, scanning in both axes to make sure you have a single interior wall puncture with the absolute smallest needle micropuncture or something similar so that your access point is meticulous because that is really going to dictate the flow of everything else afterwards.
Then the final tip is that when you're done with the procedure you have to get the sheath out and you have to control your vascular access. I think Perclose as a device, is really a technology you have to master if you're performing any large-bore femoral access. You really have to learn the pre-close technique and how to do it effectively and then that's going to then facilitate safe closure of your large-bore arteriotomy. It's really worth going through and rehearsing that in non-large-bore access so that you become facile when you're faced with the large-bore situation. It also permits some level of control that if there's a vascular complication, particularly now with the rewiring reaccess sheath, that you're maintaining wire control and you're really set up to be able to manage any adverse event at the point of a sheath removal.
Alex, I want to thank you for going over the top three tips for us. Just to quickly review. Number one, the devil's in the details. Taking some time and effort with vascular access is just as important to the success for your procedure as with your PCI. Two, that multi-modality imaging can adjunct your procedure and really lead to the best outcomes and mastery of those skills is important. Three, getting some cadence and comfort with closure devices can really augment the outcomes for vascular access and perhaps practicing on smaller-bore cases can get you comfortable. We very much appreciate it.
This is Shon Chakrabarti with Alex Truesdell for ProtectedPCI.com. Thank you.
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Quick Tips on Access and Closure
Dr. Alex Truesdell provides his top 3 tips for safe access and closure with the Impella device which include utilizing all of your senses, developing a rhythm, and more. Watch the video to learn more.
To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: abiomed.com/important-safety-information