Once in the correct position, a 0.035- or 0.038-inch J-tip polytetrafluoroethylene (Teflon)–coated guidewire is advanced through the needle into the artery. The backflow of blood should be solid and pulsatile if not, one should suspect that the needle is either not freely or not at all in the lumen of the CFA. 19.3), an 18-gauge thin-walled needle is inserted at a 30- to 45-degree angle into the CFA. Once conscious sedation and local anesthesia with 1% lidocaine (Xylocaine) are accomplished, a small transverse skin incision is made, and using the modified Seldinger technique ( Fig. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Artery Access with Ultrasound Trial). During needle advancement, the anterior wall of the vessel is kept under the central target line, which indicates the path of the needle. C, The probe is moved superiorly until the common femoral artery ( CFA) is visualized. Compression is used to differentiate arteries from the femoral vein ( FV). B, The right femoral artery bifurcation is imaged in the axial plane, identifying the separation of the profunda femoral artery ( PFA) and superficial femoral artery (SFA). The vessel bifurcation is kept inferior to the probe at the time of insertion. A, The attached needle guide fixes the needle's angle of entry to intersect the vessel at the imaging plane 1.5 cm, 2.5 cm, or 3.5 cm below the skin, depending on the guide chosen. Further, a position off the femoral head does not leave an optimally firm backboard for hemostatic compression.ĮFIGURE 19.4. 27 The critical importance of the right location cannot be overemphasized, because too high of a location increases the risk of retroperitoneal hematoma, and too low increases the risk of pseudoaneurysm, AV fistula formation, and cannulation of the superficial femoral artery with sizes too small to accommodate any larger-sized sheaths or vascular closure devices. Ultrasound has been shown to improve first-pass success rates, reduce vascular complications in general, and might be useful particularly in patients with a diffuse pulse caused by scarring after multiple prior procedures. Alternatively, ultrasound can be used to define the anatomy ( eFig. In clinical practice the optimal point of skin entry over the inferior edge of the femoral head is therefore often identified under fluoroscopy using a hemostatic clamp. The inguinal crease can be misleading in obese as well as very thin individuals. Familiarity with the anatomy is important, and the point of entry is 1 to 3 cm (1 to 2 fingerbreadths) below the inguinal ligament, in line with the palpable course of the CFA ( Fig. The standard access for many years has been the common femoral artery (CFA), also known as the Judkins technique. Zipes MD, in Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2019 Percutaneous Femoral Artery Technique
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