Femoral Artery Access with Ultrasound Guidance Walter A

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Femoral Artery Access with Ultrasound Guidance Walter A. Tan, MD, MS Director, Structural Heart

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

Outline o Search for target o Confirm target o Hit target Wake. Med Health

Outline o Search for target o Confirm target o Hit target Wake. Med Health & Hospitals Raleigh, North Carolina

FAUST: Ultrasound RCT Outcomes (femoral) Seto AH, Abu-Fadel MS, Sparling JM. JACC CV Interv

FAUST: Ultrasound RCT Outcomes (femoral) Seto AH, Abu-Fadel MS, Sparling JM. JACC CV Interv ’ 10; 3: 751

FAUST: CFA cannulation in hi risk pts Seto AH, Abu-Fadel MS, Sparling JM. JACC

FAUST: CFA cannulation in hi risk pts Seto AH, Abu-Fadel MS, Sparling JM. JACC CV Interv ’ 10; 3: 751

RAUST: Ultrasound RCT in radial artery Seto AH, et al. JACC CV Interv ’

RAUST: Ultrasound RCT in radial artery Seto AH, et al. JACC CV Interv ’ 15; 8: 283

RAUST: Ultrasound RCT in radial artery Seto AH, et al. JACC CV Interv ’

RAUST: Ultrasound RCT in radial artery Seto AH, et al. JACC CV Interv ’ 15; 8: 283

Outline o Search for target o Confirm target o Hit target Wake. Med Health

Outline o Search for target o Confirm target o Hit target Wake. Med Health & Hospitals Raleigh, North Carolina

Palpatory method – good, but not good enough! “Strongest femoral pulse” • Projected over

Palpatory method – good, but not good enough! “Strongest femoral pulse” • Projected over CFA in 92. 7% limbs (BR J Radiol 1990; 63: 602 -604) • Weak in shock; some obese and PAD pts Wake. Med Health & Hospitals Raleigh, North Carolina

Seeing is powerful to achieve goal/target

Seeing is powerful to achieve goal/target

Hope vs reality – try this with your eyes closed

Hope vs reality – try this with your eyes closed

Hope vs Reality

Hope vs Reality

Special Cases: Obese patients

Special Cases: Obese patients

Outline o Search for target o Confirm target – artery, not vein lymph node,

Outline o Search for target o Confirm target – artery, not vein lymph node, or anything else! o Hit target Wake. Med Health & Hospitals Raleigh, North Carolina

Please, no collateral damage (“friendly” fire)

Please, no collateral damage (“friendly” fire)

Please, no collateral damage (“friendly” fire) X Target is Femoral artery (CFA)

Please, no collateral damage (“friendly” fire) X Target is Femoral artery (CFA)

Please, no collateral damage (“friendly” fire) Lymph Nodes X Fem VEIN

Please, no collateral damage (“friendly” fire) Lymph Nodes X Fem VEIN

Calcification Axial Longitudinal

Calcification Axial Longitudinal

Outline o Search for target o Confirm target o Hit target – inferior common

Outline o Search for target o Confirm target o Hit target – inferior common femoral artery (CFA)! Wake. Med Health & Hospitals Raleigh, North Carolina

Our mental picture is FICTIONAL Myth of CFA predictability Below IEA loop Above bifurc

Our mental picture is FICTIONAL Myth of CFA predictability Below IEA loop Above bifurc Pitta SR, Prasad A, Kumar G, Holmes DR. CCI ‘ 11; 78: 294 -299

LOW retroperitoneal border! Wake. Med Health & Hospitals Raleigh, North Carolina

LOW retroperitoneal border! Wake. Med Health & Hospitals Raleigh, North Carolina

HIGH femoral bifurcation! Wake. Med Health & Hospitals Raleigh, North Carolina

HIGH femoral bifurcation! Wake. Med Health & Hospitals Raleigh, North Carolina

Variable inguinal boundaries (inf epig artery) Hope vs Reality Paul Jacques, MD (UNC VIR)

Variable inguinal boundaries (inf epig artery) Hope vs Reality Paul Jacques, MD (UNC VIR)

Variable inguinal boundaries (inf epig artery) The peritoneal boundary: 1. Variable 2. Can’t be

Variable inguinal boundaries (inf epig artery) The peritoneal boundary: 1. Variable 2. Can’t be seen 3. Imprecise correlation to landmarks (crease, ligament, arteries) Paul Jacques, MD (UNC VIR)

Reboot your brain “ “

Reboot your brain “ “

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

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

More is at stake now: Large devices

More is at stake now: Large devices

A more anti-coagulated world and Higher risk Patients: Age + CKD + CHF +

A more anti-coagulated world and Higher risk Patients: Age + CKD + CHF + PVD Etc, etc Circulation 2009; 119: 1873 -1882 Wake. Med Health & Hospitals Raleigh, North Carolina

Outline o Search for target o Confirm target o Hit target Wake. Med Health

Outline o Search for target o Confirm target o Hit target Wake. Med Health & Hospitals Raleigh, North Carolina

Summary o Reliable femoral access is mandatory o Tactile and fluoro are outdated standards

Summary o Reliable femoral access is mandatory o Tactile and fluoro are outdated standards o Master ultrasound learning curve Wake. Med Health & Hospitals Raleigh, North Carolina

Femoral Artery Access with Ultrasound Guidance Walter A. Tan, MD, MS Director, Structural Heart

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

Ultrasound gives clue to high fem bifurc Unpredictable high bifurcations!

Ultrasound gives clue to high fem bifurc Unpredictable high bifurcations!

Femoral Artery Access with Ultrasound Guidance Walter AFemoral Artery Access with Ultrasound Guidance Walter A
Debate The Femoral Artery Common Femoral Popliteal ArteryDebate The Femoral Artery Common Femoral Popliteal Artery
Radial artery approach versus femoral artery approach inRadial artery approach versus femoral artery approach in
ULTRASOUND SCANNING Introduction to Ultrasound Ultrasound Scanning PhysicsULTRASOUND SCANNING Introduction to Ultrasound Ultrasound Scanning Physics
Ultrasound Gel Ultrasound Blue Gel Ultrasound Clear GelUltrasound Gel Ultrasound Blue Gel Ultrasound Clear Gel
Ultrasound Gel Ultrasound Blue Gel Ultrasound Clear GelUltrasound Gel Ultrasound Blue Gel Ultrasound Clear Gel
Femoral Artery Access Using Landmarks and Fluoroscopy ZoltanFemoral Artery Access Using Landmarks and Fluoroscopy Zoltan
Antegrade Femoral and Retrograde Popliteal Artery Access AravindaAntegrade Femoral and Retrograde Popliteal Artery Access Aravinda
Access Basics Femoral Artery and Vein Andr CAccess Basics Femoral Artery and Vein Andr C
Femoral Artery Access Using Landmarks and Fluoroscopy ZoltanFemoral Artery Access Using Landmarks and Fluoroscopy Zoltan
Femoral Artery Access Using Landmarks and Fluoroscopy ZoltanFemoral Artery Access Using Landmarks and Fluoroscopy Zoltan
The Femoral Arterial Access with Ultrasound Trial FAUSTThe Femoral Arterial Access with Ultrasound Trial FAUST
Femoral n The femoral nerve is the largestFemoral n The femoral nerve is the largest
Restrictor inserter Femoral Brush Femoral sponge Cement restrictorsRestrictor inserter Femoral Brush Femoral sponge Cement restrictors
FEMORAL SHAFT FRACTUTES The femoral shaft is wellFEMORAL SHAFT FRACTUTES The femoral shaft is well
Femoral Hernia Femoral Canal It occupies the mostFemoral Hernia Femoral Canal It occupies the most
Femoral neck fractures Learning objectives Classify femoral neckFemoral neck fractures Learning objectives Classify femoral neck
Herzlich Willkommen J Walter Jrgen Walter Jrgen WalterHerzlich Willkommen J Walter Jrgen Walter Jrgen Walter
Walter Dean Myers Walter Dean Myers Walter DeanWalter Dean Myers Walter Dean Myers Walter Dean
Primary Stenting of the Superficial Femoral Artery inPrimary Stenting of the Superficial Femoral Artery in
Results of common femoral artery thromboendarterectomy evaluation ofResults of common femoral artery thromboendarterectomy evaluation of
Superficial femoral artery stenoses Characteristics of progressing lesionsSuperficial femoral artery stenoses Characteristics of progressing lesions
Angiographic Features of Atherosclerotic Superficial Femoral Artery DiseaseAngiographic Features of Atherosclerotic Superficial Femoral Artery Disease
Intraoperative superficial femoral artery balloon angioplasty and poplitealIntraoperative superficial femoral artery balloon angioplasty and popliteal