Large-bore Access and Closure: Optimizing Vascular Access and Management of Complications

Purpose of ReviewThe goal of this review is to provide the reader with an overview of how to safely obtain large-bore access, descriptions of closure devices and techniques, and methods of identifying and troubleshooting common complications.Recent FindingsTraditional methods of femoral access utilizing only anatomic landmarks should be supplemented with preprocedural imaging, ultrasound guidance, and micropuncture to ensure the adequacy of the femoral access for the intended procedure as well as to reduce the risk of complications. Closure of larger arteriotomies requires familiarity with both suture-based devices as well as collagen-based devices. A familiarity with dedicated closure devices is also necessary as each has its own learning curve as well as risks and benefits. Large-bore access carries increased risks of complications including bleeding, perforation, pseudoaneurysms, distal limb ischemia, and arteriovenous fistulas.Large-bore access is rapidly becoming a skill necessary for all interventional cardiologists. Due to the increased risks involved, familiarity with appropriate techniques and bailout strategies is critical.