Skip to main content

Guide to Vascular Access: Femoral, Radial, and Venous Access

  • Chapter
  • First Online:
  • 1003 Accesses

Abstract

Vascular access is a core element of many interventional procedures and is the conduit through which intravascular treatment, devices, and therapies are delivered in a minimally invasive fashion. The foundational components of obtaining successful vascular access cross over into many other percutaneous procedures that an interventionalist would need to be comfortable and familiar with in order to provide safe and effective patient care. This chapter will discuss the general principles of vascular access including vessel selection, techniques for visualizing and evaluating vessels under ultrasound, general steps in obtaining vascular access, and the more detailed nuances of accessing specific arteries and veins. It will also include details pertaining to radial artery access, which has been gaining significant momentum over the past several years. Additional discussion will include the use of closure devices, benefits and risks of each mode of access, and how to recognize and prevent complications associated with vascular access.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Sobolev M, Slovut DP, Lee Chang A, Shiloh AL, Eisen LA. Ultrasound-guided catheterization of the femoral artery: a systematic review and meta-analysis of randomized controlled trials. J Invasive Cardiol. 2015;27(7):318–23.

    PubMed  Google Scholar 

  2. Sharma PS, Padala SK, Gunda S, Koneru JN, Ellenbogen KA. Vascular complications during catheter ablation of cardiac arrhythmias: a comparison between vascular ultrasound guided access and conventional vascular access. J Cardiovasc Electrophysiol. 2016;27(10):1160–6.

    Article  PubMed  Google Scholar 

  3. AIUM. Practice parameter for the performance of selected ultrasound-guided procedures. J Ultrasound Med Off J Am Inst Ultrasound Med. 2016;35(9):1–40.

    Google Scholar 

  4. Saugel B, Scheeren TWL, Teboul J-L. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21(1):225.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chapman GA, Johnson D, Bodenham AR. Visualisation of needle position using ultrasonography. Anaesthesia. 2006;61(2):148–58.

    Article  CAS  PubMed  Google Scholar 

  6. Sandgren T, Sonesson B, Ahlgren ÅR, Länne T. The diameter of the common femoral artery in healthy human: influence of sex, age, and body size. J Vasc Surg. 1999;29(3):503–10.

    Article  CAS  PubMed  Google Scholar 

  7. Irani F, Kumar S, Colyer WR. Common femoral artery access techniques: a review. J Cardiovasc Med (Hagerstown). 2009;10(7):517–22.

    Article  Google Scholar 

  8. Rupp SB, Vogelzang RL, Nemcek AA, Yungbluth MM. Relationship of the inguinal ligament to pelvic radiographic landmarks: anatomic correlation and its role in femoral arteriography. J Vasc Interv Radiol. 1993;4(3):409–13.

    Article  CAS  PubMed  Google Scholar 

  9. Dudeck O, Teichgraeber U, Podrabsky P, Lopez Haenninen E, Soerensen R, Ricke J. A randomized trial assessing the value of ultrasound-guided puncture of the femoral artery for interventional investigations. Int J Cardiovasc Imaging. 2004;20(5):363–8.

    Article  PubMed  Google Scholar 

  10. Fischman AM, Swinburne NC, Patel RS. A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol. 2015;18(2):58–65.

    Article  PubMed  Google Scholar 

  11. Kato F, Sato Y, Yuasa N, Abo D, Sakuhara Y, Oyama N, et al. Reduction of bed rest time after transfemoral noncardiac angiography from 4 hours to 2 hours: a randomized trial and a one-arm study. J Vasc Interv Radiol. 2009;20(5):587–92.

    Article  PubMed  Google Scholar 

  12. Kalish J, Eslami M, Gillespie D, Schermerhorn M, Rybin D, Doros G, et al. Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates. J Vasc Surg. 2015;61(5):1231–8.

    Article  PubMed  Google Scholar 

  13. Simon A, Bumgarner B, Clark K, Israel S. Manual versus mechanical compression for femoral artery hemostasis after cardiac catheterization. Am J Crit Care. 1998;7(4):308–13.

    Article  CAS  PubMed  Google Scholar 

  14. Amin FR, Yousufuddin M, Stables R, Shamim W, Al-Nasser F, Coats AJ, et al. Femoral haemostasis after transcatheter therapeutic intervention: a prospective randomised study of the angio-seal device vs. the femostop device. Int J Cardiol. 2000;76(2–3):235–40.

    Article  CAS  PubMed  Google Scholar 

  15. Pancholy S, Coppola J, Patel T, Roke-Thomas M. Prevention of radial artery occlusion-patent hemostasis evaluation trial (PROPHET study): a randomized comparison of traditional versus patency documented hemostasis after transradial catheterization. Catheter Cardiovasc Interv. 2008;72(3):335–40.

    Article  PubMed  Google Scholar 

  16. Lund C, Nes RB, Ugelstad TP, Due-Tønnessen P, Andersen R, Hol PK, et al. Cerebral emboli during left heart catheterization may cause acute brain injury. Eur Heart J. 2005;26(13):1269–75.

    Article  PubMed  Google Scholar 

  17. Omran H, Schmidt H, Hackenbroch M, Illien S, Bernhardt P, von der Recke G, et al. Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study. Lancet. 2003;361(9365):1241–6.

    Article  PubMed  Google Scholar 

  18. Hildick-Smith DJ, Ludman PF, Lowe MD, Stephens NG, Harcombe AA, Walsh JT, et al. Comparison of radial versus brachial approaches for diagnostic coronary angiography when the femoral approach is contraindicated. Am J Cardiol. 1998;81(6):770–2.

    Article  CAS  PubMed  Google Scholar 

  19. Bertrand OF, Bélisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, et al. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J. 2012;163(4):632–48.

    Article  PubMed  Google Scholar 

  20. Keefe NA, Haskal ZJ, Park AW, Angle JF. IR playbook: a comprehensive introduction to interventional radiology. Cham: Springer International; 2018.

    Book  Google Scholar 

  21. Campeau L. Percutaneous radial artery approach for coronary angiography. Catheter Cardiovasc Diagn. 1989;16(1):3–7.

    Article  CAS  Google Scholar 

  22. Barbeau GR, Arsenault F, Dugas L, Simard S, Larivière MM. Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen’s test in 1010 patients. Am Heart J. 2004;147(3):489–93.

    Article  PubMed  Google Scholar 

  23. Hirai M, Kawai S. False positive and negative results in Allen test. J Cardiovasc Surg. 1980;21(3):353–60.

    CAS  Google Scholar 

  24. Yoo BS, Yoon J, Ko JY, Kim JY, Lee SH, Hwang SO, et al. Anatomical consideration of the radial artery for transradial coronary procedures: arterial diameter, branching anomaly and vessel tortuosity. Int J Cardiol. 2005;101(3):421–7.

    Article  PubMed  Google Scholar 

  25. Kwon SW, Cha JJ, Rhee JH. Prone position coronary angiography due to intractable back pain: another merit of transradial approach compared to transfemoral approach. J Invasive Cardiol. 2012;24(11):605–7.

    PubMed  Google Scholar 

  26. Rigatelli G, Zuin M, Dell’Avvocata F, Vassiliev D. Topical anaesthesia before transradial approach for supraoartic vessels angiography and stenting in the elderly: a feasible alternative. J Geriatr Cardiol. 2017;14(10):644–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Beyer AT, Ng R, Singh A, Zimmet J, Shunk K, Yeghiazarians Y, et al. Topical nitroglycerin and lidocaine to dilate the radial artery prior to transradial cardiac catheterization: a randomized, placebo-controlled, double-blind clinical trial: the PRE-DILATE study. Int J Cardiol. 2013;168(3):2575–8.

    Article  PubMed  Google Scholar 

  28. Ezhumalai B, Satheesh S, Jayaraman B. Effects of subcutaneously infiltrated nitroglycerin on diameter, palpability, ease-of-puncture and pre-cannulation spasm of radial artery during transradial coronary angiography. Indian Heart J. 2014;66(6):593–7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rathore S, Stables RH, Pauriah M, Hakeem A, Mills JD, Palmer ND, et al. Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study. JACC Cardiovasc Interv. 2010;3(5):475–83.

    Article  PubMed  Google Scholar 

  30. Schulz-Schüpke S, Helde S, Gewalt S, Ibrahim T, Linhardt M, Haas K, et al. Comparison of vascular closure devices vs manual compression after femoral artery puncture: the ISAR-CLOSURE randomized clinical trial. JAMA. 2014;312(19):1981–7.

    Article  PubMed  Google Scholar 

  31. Le Corvoisier P, Gellen B, Lesault P-F, Cohen R, Champagne S, Duval A-M, et al. Ambulatory transradial percutaneous coronary intervention: a safe, effective, and cost-saving strategy. Catheter Cardiovasc Interv. 2013;81(1):15–23.

    Article  PubMed  Google Scholar 

  32. Mitchell MD, Hong JA, Lee BY, Umscheid CA, Bartsch SM, Don CW. Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention. Circ Cardiovasc Qual Outcomes. 2012;5(4):454–62.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, Politi L, Rigattieri S, Pendenza G, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60(24):2481–9.

    Article  PubMed  Google Scholar 

  34. Mehta SR, Jolly SS, Cairns J, Niemela K, Rao SV, Cheema AN, et al. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without st-segment elevation. J Am Coll Cardiol. 2012;60(24):2490–9.

    Article  PubMed  Google Scholar 

  35. Cooper CJ, El-Shiekh RA, Cohen DJ, Blaesing L, Burket MW, Basu A, et al. Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J. 1999;138(3 Pt 1):430–6.

    Article  CAS  PubMed  Google Scholar 

  36. Hibbert B, Simard T, Wilson KR, Hawken S, Wells GA, Ramirez FD, et al. Transradial versus transfemoral artery approach for coronary angiography and percutaneous coronary intervention in the extremely obese. JACC Cardiovasc Interv. 2012;5(8):819–26.

    Article  PubMed  Google Scholar 

  37. Eichhöfer J, Horlick E, Ivanov J, Seidelin PH, Ross JR, Ing D, et al. Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: a large single-center experience. Am Heart J. 2008;156(5):864–70.

    Article  PubMed  Google Scholar 

  38. Hamon M, Gomes S, Clergeau M-R, Fradin S, Morello R, Hamon M. Risk of acute brain injury related to cerebral microembolism during cardiac catheterization performed by right upper limb arterial access. Stroke. 2007;38(7):2176–9.

    Article  PubMed  Google Scholar 

  39. Medtronic. DxTerity & DxTerity TRA diagnostic catheters. https://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/diagnostic-catheters.html. Accessed 9 Mar 2020.

  40. Hind D, Calvert N, McWilliams R, Davidson A, Paisley S, Beverley C, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ. 2003;327(7411):361.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 2015;1(1):CD011447.

    PubMed  Google Scholar 

  42. Porth CJ, Bamrah VS, Tristani FE, Smith JJ. The Valsalva maneuver: mechanisms and clinical implications. Heart Lung J Crit Care. 1984;13(5):507–18.

    CAS  Google Scholar 

  43. Knutstad K, Hager B, Hauser M. Radiologic diagnosis and management of complications related to central venous access. Acta Radiol (Stockh Swed 1987). 2003;44(5):508–16.

    Article  CAS  Google Scholar 

  44. Netter FH. Atlas of human anatomy e-book. Philadelphia: Elsevier; 2017.

    Google Scholar 

  45. Ji D, Gill AE, Ermentrout RM, Hawkins CM. Thrombogenic superior vena cava syndrome from long-standing central venous access in a 5-year-old patient treated with balloon-expandable stents. J Radiol Case Rep. 2018;12(4):15–22.

    PubMed  PubMed Central  Google Scholar 

  46. Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 2016;18(2):234–8.

    Article  PubMed  Google Scholar 

  47. Castro D, Martin Lee LM, Gossman W. Femoral vein central venous access. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK459255/. Accessed 9 Mar 2020.

    Google Scholar 

  48. Noori VJ, Eldrup-Jørgensen J. A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg. 2018;68(3):887–99.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Samuel Z. Maron .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Maron, S.Z., Tangel, M.R., Fischman, A.M. (2021). Guide to Vascular Access: Femoral, Radial, and Venous Access. In: Rastinehad, A.R., Siegel, D.N., Wood, B.J., McClure, T. (eds) Interventional Urology . Springer, Cham. https://doi.org/10.1007/978-3-030-73565-4_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-73565-4_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-73564-7

  • Online ISBN: 978-3-030-73565-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics