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Objectives: The aim of the study was to document the frequency of optimal femoral artery access location and its correlation with vascular complications in contemporary practice. Background: Vascular access bleeding during coronary interventions is associated with adverse outcomes. A potential strategy for reducing access-site bleeding is to achieve optimal location for the femoral access. However, there is a paucity of data on how well this goal is achieved in clinical practice using anatomical landmarks. Methods: We retrospectively evaluated femoral angiograms of 300 patients undergoing percutaneous coronary intervention to identify the location of the access that had been performed using anatomical landmarks. Patients were divided into two groups based on the location of the arterial access: above the femoral bifurcation but below the inferior border of the inferior epigastric artery (optimal location) and those that were either above or below these landmarks (suboptimal location). Frequency of access site complications was recorded. Results: The femoral artery access site was located outside the optimal location in 38 (13.0%) patients. There was no significant difference regards to baseline characteristics. Overall, access-related complications occurred in 17 (5.7%) patients. Vascular complications were significantly more frequent in patients who had a femoral artery access outside the optimal location (18% vs. 4%, P < 0.001). Conclusions: The femoral artery access site is not at the optimal location in a significant proportion of patients, and this is associated with an increased risk of vascular complications. Improving the rates of optimal arterial access by routine use of fluoroscopy or ultrasound guidance has the potential of reducing vascular complications and improving outcomes. © 2011 Wiley-Liss, Inc.

Objective: To report complications in a consecutive series of patients undergoing percutaneous left ventricular apical puncture (LVAP) and sheath placement for diagnostic or interventional procedures. Background: Percutaneous LVAP is only rarely used to provide hemodynamic data in the presence of mechanical prosthetic valves. Recently, LVAP has been used to facilitate complex interventional procedures such as paravalvular leak closures. These frequently necessitate placement of 4–6 F sheaths, rather than smaller needles. Optimal technique and outcomes are largely unknown for this uncommon procedure. Methods: We retrospectively analyzed 32 patients undergoing LVAP with echocardiographic and fluoroscopic guidance at our institution between 2002 and 2009. These patients were referred to the cardiac catheterization laboratory for hemodynamic assessment to rule out prosthetic dysfunction and or to facilitate paravalvular leak closure. Sheaths ranged from 4 to 6 F were removed at the end of the procedure after reversing any anticoagulation. No specific closure devices were used for hemostasis. Frequency of access site complications associated with LVAP recorded. Results: Apical access site related complications were higher in patients requiring LVAP for intervention than for diagnostic purposes (25% vs. 12.5%). Hemothorax was the most frequent serious complication occurring in 6 (19%) patients and frequently required intervention 5(16%). Three patients had local bleeding with no drop in hemoglobin or need for intervention. Conclusions: LVAP is associated with a significant incidence of access-related complications. There is a need for safe and reliable methods of closing percutaneous LVAP access sites. © 2010 Wiley-Liss, Inc.