Percutaneous placement and removal of large diameter femoral artery sheaths with the prostar XL device

INTRODUCTION
For successful transcatheter aortic valve implantation (TAVI) as well as endovascular abdominal aneurysm repair (EVAR), and thoracic endovascular aneurysm repair (TEVAR), the insertion of large diameter arterial sheaths is necessary. Because of the necessary caliber of the sheaths, usually between 18 and 24 F (6-8 mm), the access is almost exclusively chosen via the femoraliliac arteries. In the past years we gradually changed our technique from a surgical cut-down to a percutaneous technique in all patients. The advantages of this less invasive technique are increased patient comfort immediately after the procedure and a diminished requirement for anesthetic drugs during and after the procedure. In most patients, the percutaneous technique of placement and removal of large diameter femoral arterial sheaths can be performed under local anesthesia only. In other words, the need for the presence of an anesthesiological team is dictated by the condition of the patient only and, to some extent, to the length of the procedure and not by the necessity to perform an open-surgical cut-down in the groin.