Arterial access: Needle puncture, guidewire, and subsequent sheath/catheter introduction, providing arterial access for angiography/vascular intervention
Common femoral artery (CFA) access
Most frequent access site
Majority of punctures retrograde; antegrade can be done for leg interventions
Radial artery access
Alternative to CFA access
Transradial access (TRA) vs. CFA
Consider in patients on anticoagulation
Reduced complications in obese patients
Reduced recovery time
No closure devices necessary: Reduced procedural cost, no foreign body deployed
Requires preprocedure Barbeau test
Brachial artery access
Alternative access for anticipated upper extremity intervention or CFA/radial access not feasible
Low brachial artery access preferred vs. high access
Axillary artery access has higher complication rate than femoral or radial access
Hematoma may track within medial brachial fascial compartment and compress brachial plexus
High brachial artery access risks similar to axillary
Popliteal
Nontraditional access, usually for leg intervention
Tibiopedal
Treatment of chronic limb ischemia; limb salvage
Retrograde access; typically following failed antegrade recanalization of infrapopliteal occlusions in ischemic angiosome
Aortic access
Direct needle puncture of abdominal aorta with subsequent sheath/catheter placement
Selective arterial catheterization difficult
Often used for translumbar endoleak repair
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Selected References
Gayed A et al: Society of Interventional Radiology quality improvement standards on radial artery access. J Vasc Interv Radiol. 32(5):761.e1-21, 2021
Tsigkas G et al: Transradial access through the anatomical snuffbox: results of a feasibility study. Hellenic J Cardiol. 62(3):201-5, 2021
Adnan SM et al: Radial versus femoral arterial access for trauma endovascular interventions: a noninferiority study. J Trauma Acute Care Surg. 89(3):458-63, 2020
Parikh A et al: Distal radial and ulnar arteries: the alternative forearm access. Curr Treat Options Cardiovasc Med. 22(1):1, 2020
Patel IJ et al: Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 30(8):1168-84.e1, 2019
Posham R et al: Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1,500 cases. J Vasc Interv Radiol. 27(2):159-66, 2016
Dobrow EM et al: Retrograde tibiopedal access for the treatment of critical limb ischemia. Tech Vasc Interv Radiol. 18(2):66-75, 2015
Fischman AM et al: A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol. 18(2):58-65, 2015
Steve Lee K et al: Brachial artery access. Tech Vasc Interv Radiol. 18(2):87-92, 2015
Resnick NJ et al: Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol. 25(3):443-7, 2014
Patel IJ et al: Addendum of newer anticoagulants to the SIR Consensus Guideline. J Vasc Interv Radiol. 24(5):641-5, 2013
Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
Haude M et al: Femoral artery puncture. EuroIntervention. 5(6):751, 2010
Alvarez-Tostado JA et al: The brachial artery: a critical access for endovascular procedures. J Vasc Surg. 49(2):378-85; discussion 385, 2009
Turi ZG: Fluoroscopy guided vascular access: asking the right question, but getting the wrong answer? Catheter Cardiovasc Interv. 74(4):540-2, 2009
Montero-Baker M et al: Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 15(5):594-604, 2008
Taha MM et al: Access site complications with carotid angioplasty and stenting. Surg Neurol. 68(4):431-7, 2007
Yilmaz S et al: Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. J Endovasc Ther. 12(6):714-22, 2005
Barbeau GR et al: Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients. Am Heart J. 147(3):489-93, 2004
Chan TY et al: Position of skin puncture in translumbar aortography. Acta Radiol. 34(6):631-2, 1993
Rupp SB et al: Relationship of the inguinal ligament to pelvic radiographic landmarks: anatomic correlation and its role in femoral arteriography. J Vasc Interv Radiol. 4(3):409-13, 1993
Bakal CW et al: Translumbar arch aortography: a retrospective controlled study of usefulness, technique, and safety. Radiology. 178(1):225-8, 1991
Smith DC et al: Medial brachial fascial compartment syndrome: anatomic basis of neuropathy after transaxillary arteriography. Radiology. 173(1):149-54, 1989
Lipchik EO et al: Percutaneous brachial artery catheterization. Radiology. 160(3):842-3, 1986
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Procedure
Post Procedure
TERMINOLOGY
Definitions
Arterial access: Needle puncture, guidewire, and subsequent sheath/catheter introduction, providing arterial access for angiography/vascular intervention
Common femoral artery (CFA) access
Most frequent access site
Majority of punctures retrograde; antegrade can be done for leg interventions
Radial artery access
Alternative to CFA access
Transradial access (TRA) vs. CFA
Consider in patients on anticoagulation
Reduced complications in obese patients
Reduced recovery time
No closure devices necessary: Reduced procedural cost, no foreign body deployed
Requires preprocedure Barbeau test
Brachial artery access
Alternative access for anticipated upper extremity intervention or CFA/radial access not feasible
Low brachial artery access preferred vs. high access
Axillary artery access has higher complication rate than femoral or radial access
Hematoma may track within medial brachial fascial compartment and compress brachial plexus
High brachial artery access risks similar to axillary
Popliteal
Nontraditional access, usually for leg intervention
Tibiopedal
Treatment of chronic limb ischemia; limb salvage
Retrograde access; typically following failed antegrade recanalization of infrapopliteal occlusions in ischemic angiosome
Aortic access
Direct needle puncture of abdominal aorta with subsequent sheath/catheter placement
Selective arterial catheterization difficult
Often used for translumbar endoleak repair
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Selected References
Gayed A et al: Society of Interventional Radiology quality improvement standards on radial artery access. J Vasc Interv Radiol. 32(5):761.e1-21, 2021
Tsigkas G et al: Transradial access through the anatomical snuffbox: results of a feasibility study. Hellenic J Cardiol. 62(3):201-5, 2021
Adnan SM et al: Radial versus femoral arterial access for trauma endovascular interventions: a noninferiority study. J Trauma Acute Care Surg. 89(3):458-63, 2020
Parikh A et al: Distal radial and ulnar arteries: the alternative forearm access. Curr Treat Options Cardiovasc Med. 22(1):1, 2020
Patel IJ et al: Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 30(8):1168-84.e1, 2019
Posham R et al: Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1,500 cases. J Vasc Interv Radiol. 27(2):159-66, 2016
Dobrow EM et al: Retrograde tibiopedal access for the treatment of critical limb ischemia. Tech Vasc Interv Radiol. 18(2):66-75, 2015
Fischman AM et al: A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol. 18(2):58-65, 2015
Steve Lee K et al: Brachial artery access. Tech Vasc Interv Radiol. 18(2):87-92, 2015
Resnick NJ et al: Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol. 25(3):443-7, 2014
Patel IJ et al: Addendum of newer anticoagulants to the SIR Consensus Guideline. J Vasc Interv Radiol. 24(5):641-5, 2013
Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
Haude M et al: Femoral artery puncture. EuroIntervention. 5(6):751, 2010
Alvarez-Tostado JA et al: The brachial artery: a critical access for endovascular procedures. J Vasc Surg. 49(2):378-85; discussion 385, 2009
Turi ZG: Fluoroscopy guided vascular access: asking the right question, but getting the wrong answer? Catheter Cardiovasc Interv. 74(4):540-2, 2009
Montero-Baker M et al: Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 15(5):594-604, 2008
Taha MM et al: Access site complications with carotid angioplasty and stenting. Surg Neurol. 68(4):431-7, 2007
Yilmaz S et al: Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. J Endovasc Ther. 12(6):714-22, 2005
Barbeau GR et al: Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients. Am Heart J. 147(3):489-93, 2004
Chan TY et al: Position of skin puncture in translumbar aortography. Acta Radiol. 34(6):631-2, 1993
Rupp SB et al: Relationship of the inguinal ligament to pelvic radiographic landmarks: anatomic correlation and its role in femoral arteriography. J Vasc Interv Radiol. 4(3):409-13, 1993
Bakal CW et al: Translumbar arch aortography: a retrospective controlled study of usefulness, technique, and safety. Radiology. 178(1):225-8, 1991
Smith DC et al: Medial brachial fascial compartment syndrome: anatomic basis of neuropathy after transaxillary arteriography. Radiology. 173(1):149-54, 1989