ABSTRACT
Introduction After Seldinger contributed a method for percutaneous puncture of the femoral artery a half century ago,1 relatively little changed in vascular access and closure until the late 1970s. Standard percutaneous femoral access technique required multiple passages through the skin and thigh muscles by catheters over exchange wires, a method that occasionally resulted in loss of access, accumulation of debris in the tips of catheters, and a variety of secondary complications. Most importantly, repeated passage of catheters through the femoral puncture site resulted in fraying of the arteriotomy edge. The introduction of vascular sheaths was a significant step forward,2 allowing simultaneous pressure monitoring through a Y connector (or later a sidearm), and resulted in smoother arteriotomy edges because it eliminated the need for multiple catheter introductions though the vessel wall. Closure was entirely by external compression (Figure 23.1), largely manual but in some laboratories with mechanical compression devices, several of which remain in use (Figure 23.2).
