Clinical Report: Strategies for Managing Large-Bore Femoral Access and Closure

Overview

This report discusses the increasing use of microaxial flow pumps (mAFP) in high-risk cardiac procedures and the associated challenges of large-bore femoral access. It emphasizes the importance of effective vascular access and closure techniques to mitigate complications and improve patient outcomes.

Background

Microaxial flow pumps are critical in managing cardiogenic shock and facilitating high-risk percutaneous coronary interventions. However, the necessity for large-bore arterial access raises the risk of vascular complications, which can lead to significant morbidity and mortality. Understanding and implementing effective access and closure strategies is essential for improving patient safety and reducing healthcare costs.

Data Highlights

No numerical data provided in the article.

Key Findings

• Ultrasound- and angiography-guided puncture techniques enhance the safety of femoral access.
• Pre-closure methods are recommended for high-risk percutaneous coronary interventions.
• Post-closure methods are critical for patients with cardiogenic shock where pre-closure is not feasible.
• Recent studies indicate no significant differences in outcomes between plug-based and suture-based closure strategies.
• Individualized approaches to closure selection based on anatomy and operator experience are essential.

Clinical Implications

Healthcare professionals should prioritize the use of ultrasound-guided techniques for femoral access to minimize complications. Additionally, a tailored approach to closure methods based on patient-specific factors can enhance safety and efficacy in procedures involving microaxial flow pumps.

Conclusion

Effective management of large-bore femoral access and closure is vital in improving outcomes for patients undergoing high-risk cardiac procedures. Continued refinement of techniques and individualized strategies will further enhance patient safety.

Related Resources & Content

1. EAPCI, PubMed, 2025 -- High-risk percutaneous coronary intervention in patients with reduced left ventricular ejection fraction deemed not suitable for surgical revascularisation.
2. MANTA vs Perclose for Large-Bore Femoral Closure in Impella-Assisted High-Risk Percutaneous Coronary Intervention: Retrospective Outcomes Study, PubMed, 2025.
3. Percutaneous Micro-Robotic Approach for Targeting Type II Endoleaks in the Angio-Suite
4. Innovative Techniques for Creating Percutaneous Endovascular Arteriovenous Fistulas Using the Ellipsys® Vascular Access System: Initial Outcomes from a Study of 16 Patients
5. Journal of Gastrointestinal Surgery — Autologous Fat Transfer: A Promising Approach for Treating Complex Anal Fistulas
6. Pediatric Cardiology — Innovative Applications of the SwiftNinja Steerable Microcatheter in Pediatric Cardiac Procedures
7. High-risk percutaneous coronary intervention in patients with reduced left ventricular ejection fraction deemed not suitable for surgical revascularisation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the ESC Working Group on Cardiovascular Surgery - PubMed
8. MANTA vs Perclose for Large-Bore Femoral Closure in Impella-Assisted High-Risk Percutaneous Coronary Intervention: Retrospective Outcomes Study - PubMed
9. Microaxial Flow Pump in Infarct-Related Cardiogenic Shock - American College of Cardiology