When considering arterial access in CTO PCI, a balance is needed between anticipated procedural difficulty, planned CTO strategy and the desire to minimise the risk of vascular access-related complications. The requirement for larger French systems, particularly in more complex cases has resulted in high use of trans-femoral access in CTO PCI. This has implications for training of medical and nursing staff both in terms of both peri-procedural and post-procedural care in increasingly radial access dominant centres. The miniaturisation of angioplasty equipment continues and is expected to increase the feasibility of transradial CTO interventions.
To reduce the risk of femoral access site complications, femoral access should be achieved with fluoroscopic guidance which is readily available in every catheter lab. A strategy of US guided puncture may become more commonplace in the future.