Vascular access and closure for cardiovascular intervention

Learning objectives

  • To choose the most appropriate access site for a cardiovascular intervention.

  • Learn how to gain access and achieve closure of the radial and femoral arteries.

  • Learn how to minimise vascular complications.

  • Introduction

    Selective coronary angiography initially required surgical cut down to access the brachial artery.1 Subsequently, in 1967 Melvin Judkins described a direct percutaneous approach via the femoral artery,2 an easily palpated vessel with high procedural success that would go on to become the default arterial access route. However, despite decades of experience with femoral access, vascular complications and bleeding remain a concern and are still a significant cause of mortality in cardiovascular intervention.3 Percutaneous coronary intervention (PCI) via the radial artery was first described by Kiemeneij in 1993,4 and early studies appeared to show a virtual elimination of access site complications.<cross-ref…

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