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Obtaining Vascular Access

The femoral artery is the most commonly used arterial site of access in the United States while the radial artery access is currently gaining popularity. In 2018, radial artery access was used in 40.7 percent of procedures in the U.S.

To perform percutaneous intervention, the first step is to obtain a perfect vascular access. While a “high” sheath insertion above the inguinal ligament could increase the risk of retroperitoneal bleeding, a “low” sheath insertion into the profunda femoris or the superficial femoral artery (SFA) could result in arteriovenous fistula, pseudoaneurysm, or limb ischemia.

While the standard size (18G) or micro access needle (21G) with ultrasound or angiographic guidance can be used to obtain arterial access, the latter would be a better choice for vascular access with ultrasound guidance. The ideal location for femoral artery access is the segment of common femoral artery below the inguinal ligament [1–2 cm below the line traced from the anterosuperior iliac spine to the pubic tubercle].

In radial artery access can be done by using 20-22 gauge needle with Glide sheath catheter.

Sheaths

  • It is a plastic tube through which the equipment and various devices are delivered to perform percutaneous coronary intervention.
  • The standard sheath size is 6-8 French with different lengths (10, 25, and 45 cm).
  • Long sheath (6/7F and 45 cm in length) is particularly useful in cases that need additional support.
Femoral sheath size by different procedure type
PROCEDURE
PROCEDURE
SHEATH SIZE
Diagnostic cardiac catheterization
Diagnostic cardiac catheterization
5 Fr
PCI – most PCIs including orbital atherectomy and rotational atherectomy burr 2 mm
PCI – most PCIs including orbital atherectomy and rotational atherectomy burr 2 mm
6 Fr
PCI – most PCIs including orbital atherectomy and rotational atherectomy burr up to 2 mm
PCI – most PCIs including orbital atherectomy and rotational atherectomy burr up to 2 mm
7 Fr
Rotational atherectomy burr of 2.15 mm or 2.25 mm
Rotational atherectomy burr of 2.15 mm or 2.25 mm
8 Fr
Balloon aortic valvuloplasty
18 mm balloon
10 Fr
Balloon aortic valvuloplasty
20 mm balloon
11 Fr
Balloon aortic valvuloplasty
22 mm balloon
12 Fr
Balloon aortic valvuloplasty
23–25 mm balloon
13 Fr
Impella
2.5
13 Fr
Impella
CP
14 Fr
Impella
5.0
21 Fr
Impella
LD
21 Fr
Transcatheter aortic valve replacement
Core valve - Evolut
18 Fr
Transcatheter aortic valve replacement
Edwards SAPIEN valve
22-24 Fr

The Impella 2.5®, Impella CP®, Impella 5.0®, and Impella LD® Catheters, in conjunction with the Automated Impella Controller™ (collectively, “Impella® System Therapy”), are temporary ventricular support devices intended for short term use (≤ 4 days for the Impella 2.5 and Impella CP, and ≤ 14 days for the Impella 5.0 and Impella LD) and indicated for the treatment of ongoing cardiogenic shock that occurs immediately (< 48 hours) following acute myocardial infarction, open heart surgery, in the setting of cardiomyopathy such as peripartum cardiomyopathy, myocarditis.

The intent of Impella therapy is to reduce ventricular work, providing the circulatory support necessary to allow heart recovery and early assessment of residual myocardial function.

Diagnostic Wires

The access wire is designed to overcome standard clinical challenges providing necessary support to introduce the sheath and catheters. The wire is usually made of stainless steel or nitinol along with PTFE coated or polymer jacket cover.

A Glidewire with hydrophilic coating is mostly used to navigate through tortuous lesions while extra support wires are useful to deliver the sheath especially in tortuous and angulated vessels.

Case ExamplesEducational Content

ATHERECTOMY COMPLICATIONS

Case ExamplesEducational Content

BYPASS GRAFT COMPLICATIONS

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

Left Main DK Crush Video ID