ABSTRACT
A poorly chosen or conducted access can make case complicated and possibly make a complicated case impossible. Use of the vascular system itself to assist the therapist in arriving at the site of the lesion for treatment has tremendous appeal. The retrograde femoral puncture is the most commonly used since it is safest and offers the highest degree of versatility. Consider the need for access as a breach of the vascular system, a necessary evil that should be minimized as far as possible. The most important maneuver for successful vascular access occurs prior to the procedure, and that is choosing the puncture site. A puncture of the mid-common femoral artery is desirable. Ultrasound guidance is extremely helpful in achieving this goal. Puncture of the artery proximal to femoral head is likely to be too far proximal and to enter the external iliac artery. A right-handed operator stands on the patient’s left side for forehand delivery of the needle and guidewire.
