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

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

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

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

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

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

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

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

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

Equipment Monitors Fluoro Ultrasound (US) Sterile sleeved US Probe

Equipment Monitors Fluoro Ultrasound (US) Sterile sleeved US Probe

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

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

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

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

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

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!

Reboot your brain!

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

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

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

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

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!)

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 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

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

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

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

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

Calcification = acoustic shadowing Axial Longitudinal

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