ABSTRACT
A successful percutaneous vascular procedure begins before entering the catheterization laboratory with planning the details about procedural goals, including choosing an optimal vascular access site. This chapter discusses the technical methods for obtaining vascular access for various arterial and venous sites. It analyses the issues related to scenarios such as, obese patients, those with repeated procedures who have developed dense scar tissue, and accessing femoral bypass grafts. The chapter explores the options for vascular site hemostasis by describing commonly used closure techniques. Choosing the optimal access site affects the likelihood of procedural success. Antegrade popliteal access directed distally is indicated in percutaneous interventions for critical limb ischemia (CLI) and limb salvage procedures. Noninvasive imaging, such as CT angiography of the distal aorta and aorto-iliac bifurcation, is necessary to make precise measurements in determining procedure feasibility. The common femoral artery (CFA) is still most frequently used, accommodates most interventional and diagnos-tic tools, and is centrally located for most vascular beds.
