Vascular Access Techniques and Closure Devices

In the spirit of innovation that is foundational to the specialty, interventional radiologists continue to expand the options for arterial and venous access with the goals of expanding access to treatments, improving patient safety, comfort, and facilitating procedural technical success. While the common femoral artery remains the standard access site for many arterial interventions, the radial artery has grown into the upper extremity arterial access site of choice for a variety of procedures. Alternative arterial access techniques now extend to the distal radial and ulnar arteries as well as anterior tibial/dorsalis pedis and posterior tibial arteries. Venous interventions are extremely diverse and can be performed from the extremities, neck, and even with transvisceral or transperitoneal approaches. Minimally invasive therapy provided through transarterial and transvenous routes continues to increase for a variety of disease processes including cancer therapy, neurovascular pathology, atherosclerotic vascular disease, congenital vascular malformations, thrombectomy, and management of active hemorrhage. Several arterial access closure devices are currently available for use. In certain instances, these may be employed for large bore venous access as well. Each closure device utilizes a unique mechanism to obtain hemostasis with a goal of diminishing postprocedural bleeding and reducing procedure time. Patient-specific risk factors should be considered when determining the access site and method of hemostasis.