Femoral Artery Access with Ultrasound Guidance Walter A

Walter Tan, MD, MS I have no relevant financial relationships

Outline o Equipment o Operator o Pitfalls Wake. Med Health & Hospitals Raleigh, North

Outline o Equipment o Human interface o Pitfalls Wake. Med Health & Hospitals Raleigh,

Equipment Monitors Fluoro Ultrasound (US) Sterile sleeved US Probe

Machine-Human Interface Monitors always across you o See everything easily o Reach everything readily

Principles o Equipment o Operator o Pitfalls Wake. Med Health & Hospitals Raleigh, North

Dangerous notions – delete from your brain! 1. Nature is predictable Myth of uniformity

Main Goal is not just CFA: Sheath entering just above femoral bifurcation

Anatomy can be studied, but not predicted Hence, ultrasound ROUTINELY Retroperitoneal border is sometimes

Variable inguinal boundary (inf epig artery) May be lower! (and cannot be “seen”) Paul

Reboot #2: That the needle is predictablely seen More retroperitoneal bleeds with fluoro or

Reboot #3 That we are predictable Aiming = Bullseye (No 100% “free”-throw!)

Summary o Equipment o Human factors o Pitfalls Wake. Med Health & Hospitals Raleigh,

Summary - Reality o Equipment o Operator o Pitfalls Wake. Med Health & Hospitals

Know o plane o pilot o. Nature Wake. Med Health & Hospitals Raleigh, North

Conclusions o Equipment - Befriend and get to know o Operator – Work towards

Calcification = acoustic shadowing Axial Longitudinal

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Femoral Artery Access with Ultrasound Guidance Walter A. Tan, MD, MS Director, Structural Heart Program and Advanced Devices Wake. Med Health & Hospitals Raleigh, North Carolina

Walter Tan, MD, MS I have no relevant financial relationships

Outline o Equipment o Operator o Pitfalls Wake. Med Health & Hospitals Raleigh, North Carolina

Outline o Equipment o Human interface o Pitfalls Wake. Med Health & Hospitals Raleigh, North Carolina

Equipment Monitors Fluoro Ultrasound (US) Sterile sleeved US Probe

Machine-Human Interface Monitors always across you o See everything easily o Reach everything readily o In a relaxed and ergonomic posture

Principles o Equipment o Operator o Pitfalls Wake. Med Health & Hospitals Raleigh, North Carolina

Dangerous notions – delete from your brain! 1. Nature is predictable Myth of uniformity Below IEA loop Above bifurc Pitta SR, Prasad A, Kumar G, Holmes DR. CCI ‘ 11; 78: 294 -299

Reboot your brain!

Main Goal is not just CFA: Sheath entering just above femoral bifurcation

Anatomy can be studied, but not predicted Hence, ultrasound ROUTINELY Retroperitoneal border is sometimes low! Wake. Med Health & Hospitals Raleigh, North Carolina

Variable inguinal boundary (inf epig artery) May be lower! (and cannot be “seen”) Paul Jacques, MD (UNC VIR)

Reboot #2: That the needle is predictablely seen More retroperitoneal bleeds with fluoro or US Overshoot into retroperitoneum!!

Reboot #3 That we are predictable Aiming = Bullseye (No 100% “free”-throw!)

Summary o Equipment o Human factors o Pitfalls Wake. Med Health & Hospitals Raleigh, North Carolina

Summary - Reality o Equipment o Operator o Pitfalls Wake. Med Health & Hospitals Raleigh, North Carolina

Know o plane o pilot o. Nature Wake. Med Health & Hospitals Raleigh, North Carolina

Conclusions o Equipment - Befriend and get to know o Operator – Work towards mastery o Pitfalls – Be humble and always alert Wake. Med Health & Hospitals Raleigh, North Carolina

Femoral Artery Access with Ultrasound Guidance Walter A. Tan, MD, MS Director, Structural Heart Program and Advanced Devices Wake. Med Health & Hospitals Raleigh, North Carolina

Calcification = acoustic shadowing Axial Longitudinal