I have been using a femoral platform as my cannulation strategy of choice for the last 8 years. I have utilized this access in over 2,000 patients. I don’t order a routine pre-op CT angiogram. I pay close attention to the amount of calcification present in the artery after exposure. If there is only a posterior plaque, I proceed. I pass the guidewire into the artery towards the distal arch. If I don’t meet any resistance I will proceed with the femoral cannulation. The cannula should also be advanced with ease. If one feels resistance or an obstruction, then this access point needs to be abandoned. If one passes the cannula and feels a gritty sensation (cannula riding over plaque), this is really not a issue unless the cannula cannot be advanced. The cannula needs to be advanced completely into the artery.
I have gone to using the Medtronic BioMedicus cannula due to excellent flow characteristics and less resistance compared to others.
BSA up to 1.6 — 15 Fr. Cannula (yes, 15!)
BSA 1.7 – 2.1 — 17Fr. Cannula
BSA 2.2 and greater — 19fr. Cannula
I ALWAYS use a 25 Fr. venous cannula
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