Thinking radial, acting femoral: A novel low-cost vascular access strategy

Femoral arterial access remains indispensable for diagnostic and interventional cardiovascular procedures despite the growing adoption of transradial techniques. However, femoral access site complications such as hematoma, pseudoaneurysm, retroperitoneal hemorrhage, and arteriovenous (AV) fistula continue to contribute to procedural morbidity. Accurate arterial puncture and maintenance of stable vascular access are critical determinants of procedural safety. We describe a novel technique utilizing a radial artery puncture set, consisting of a 20G needle with an integrated microsheath, for femoral arterial access. In this prospective pilot case series, 10 consecutive patients undergoing coronary angiography, percutaneous coronary intervention, or balloon mitral valvotomy via femoral access were included. After successful femoral artery puncture, the micro-sheath was advanced into the arterial lumen to stabilize access before guidewire insertion and subsequent sheath upsizing. Femoral access was successfully achieved in all patients without crossover to conventional techniques. No access-site complications, including hematoma, pseudoaneurysm, AV fistula, retroperitoneal hemorrhage, or significant hemoglobin decline, were observed during hospitalization or at 30-day follow-up. The technique appeared feasible across a heterogeneous population, including elderly, obese, and anticoagulated patients. This approach may offer advantages over conventional and micropuncture techniques by improving needle stability and reducing repeated puncture attempts. Use of a radial artery puncture set for femoral access appears to be a simple, safe, and cost-effective alternative to standard femoral access techniques. Larger comparative studies are warranted to validate these preliminary findings.