CHAPTER 1 Vascular Access

Challenges 2 Femoral Approach 2 Standard of Technical Excellence 2 Technique The fl uoroscopically guided micropuncture access 3 Technical Tips 4 * * Angiography to check the location of femoral entry through a dilator 4 Preparations in obese patients 4 * Directing the needle 4 * If the wire cannot be inserted 5 * Sequential order for arterial and venous puncture 5 * * Kinked wire 5 * * Puncture of pulseless femoral artery 5 Trouble shooting Tricks 6 Puncture of femoral bypass graft 6 Technique Bypass graft puncture 6 Trouble shooting Tricks 6 * * * Parallel technique 6 * * * Insertion of intra aortic balloon pump through diseased iliac artery 6 * * Two catheters inserted with one puncture technique 7 Antegrade Puncture 7 Technique Common femoral artery antegrade puncture 7 Technical Tips 7 * * Manipulation of wire 7 * * Puncture of CFA with high bifurcation 8 * * Puncture with abduction and external rotation of the thigh 8 Brachial Approach 8 Axillary Puncture 8 Transeptal Approach 10 Closure Devices 10 Collagen Plug Device: Mynx 10 Clip Device: Starclose 10 The Perclose 11 Technique Preclosure of large arterial access 11 Technique Preclosure of aarge venous access 11 Technical Tips 11 * * * Differences in technical details for preclosure of venous access 11