Fluoroscopic-Guided Micropuncture Technique for Common Femoral Artery Access
Fluoroscopic-Guided Micropuncture Technique for Common Femoral Artery Access
The main objective of this proposed study is to examine if oblique projection (20- degrees
 right anterior oblique (RAO) for right femoral artery access or 20-degree left anterior
 oblique (LAO) for left femoral artery access) is superior to anterior projection (AP) for
 femoral artery access in zone 2-4 and thereby resulting in lower risk of access related
 complications.
The investigators plan to randomize 200 subjects who present for coronary angiography, bypass
 graph angiography or left heart catheterization via the femoral approach. The investigators
 will randomly assign them to either oblique projection (20-degree RAO for right femoral
 artery) or 20-degree LAO (for left femoral artery) versus AP for femoral arterial access in a
 1:1 fashion. A trained cardiologist will review the femoral artery angiogram. The
 investigators will use the scoring system used for the femoral artery access site, as
 previously reported (10). These predefined locations are as follows: zone 1 denotes femoral
 artery above the femoral head; zone 2, femoral artery from the superior border of femoral
 head to the center of the femoral head; zone 3, femoral artery in the center of the femoral
 head; zone 4, femoral artery from the center of femoral head to the inferior border of the
 femoral head; and zone 5, femoral artery below the inferior boarder of the femoral head.

 The invesigators will use micropuncture access kit for femoral artery access. Micropuncture
 needle will be advanced to the center of the femoral head and common femoral artery will be
 punctured guided by fluoroscopy. Those assigned to oblique projection will have
 fluoroscopic-guided femoral access in RAO 20 degree for right femoral artery and LAO 20
 degree for left femoral artery, while those assigned to AP will have femoral artery access in
 AP 0 degree. For both groups, the investigators will also obtain the other view as a
 reference to compare results (i.e., in the oblique group, we will save AP and vice versa). If
 the tip of the micropuncture needle were located in the femoral artery corresponding to the
 center (zone 3) or bottom third (zone 4) of the femoral head in the 20-degree RAO, 20-degree
 LAO position or zero-degree AP position, the micropuncture dilator will be advanced into the
 femoral artery, 0.018" guide wire will be exchanged with a 0.035" guide wire, and a sheath
 will be placed in the femoral artery, and the femoral angiography will be performed in the
 20-degree RAO or 20-degree LAO projection for right and left femoral artery, respectively.

 The investigators will also collect data on demographic characteristics including age, race,
 gender, as well as cardiovascular risk factors such as history of diabetes, hypertension,
 dyslipidemia, peripheral arterial disease, prior CAD, prior CVA, smoking history, family
 history of CAD, eGFR. We will also obtain data on medication history to review if they are on
 antiplatelet or anticoagulants. Those with ipsilateral access within the past 90 days will be
 excluded.
Inclusion Criteria:

 -  Patients who are undergoing cardiac catheterization or PCI

 Exclusion Criteria:

 -  Peripheral vascular disease

 -  Renal failure, Creatinine >2.5 mg/dL

 -  Hemodynamic instability, acute myocardial infarction

 -  Heart failure with EF<25%