Complex Vascular Access and Vessel Closure

INTRODUCTION TO COMPLEX VASCULAR ACCESS AND VESSEL CLOSURE The most convenient access route for peripheral arterial interventions is the common femoral artery. The femoral artery is a continuation of the external iliac artery. Its name changes as it passes deep into the inguinal ligament. The femoral artery is found at the midpoint of the inguinal ligament. The relationship of the femoral artery to other neurovascular structures passing deep into the inguinal ligament is expressed by the phrase NAVEL, useful to direct proper arterial access (Fig. 1). An arterial access without palpable pulse should not be performed because this is associated with increased complications such as bleeding, arteriovenous fistulas (AVF), or vasovagal reactions when repetitive punctures are needed.