Large bore accesses refer to accesses with a diameter of 10 French or greater and are necessary for various medical devices, including those used in transcatheter aortic valve replacement, endovascular aneurysm repair stent-grafts, and percutaneous mechanical support devices. Notably, the utilization of these devices via femoral access is steadily increasing due to advancements in technology and implantation techniques, which are expanding the pool of patients suitable for percutaneous procedures. However, procedures involving large bore devices carry a high risk of bleeding and vascular complications (VCs), impacting both morbidity and long-term mortality. In this review article, we will first discuss the incidence, determinants, and prognostic impact of VCs in patients undergoing large bore access procedures. Subsequently, we will explore the strategies developed in recent years to minimize VCs, including techniques for optimizing vascular puncture through femoral cannulation, such as the use of echo-guided access cannulation and fluoroscopic guidance. Additionally, we will evaluate existing vascular closure devices designed for large bore devices. Finally, we will consider new pharmacological strategies aimed at reducing the risk of periprocedural access-related bleeding.

中文翻译：

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使用大口径装置进行经股动脉手术的患者中尽量减少入路部位相关并发症的策略

大口径通路是指直径为 10 French 或更大的通路，是各种医疗器械所必需的通路，包括经导管主动脉瓣置换术、血管内动脉瘤修复覆膜支架和经皮机械支撑装置。值得注意的是，由于技术和植入技术的进步，通过股骨通路对这些设备的使用正在稳步增加，这扩大了适合经皮手术的患者群体。然而，涉及大口径装置的手术具有很高的出血和血管并发症 (VC) 风险，影响发病率和长期死亡率。在这篇综述文章中，我们将首先讨论接受大口径手术的患者中 VC 的发生率、决定因素和预后影响。随后，我们将探讨近年来开发的尽量减少 VC 的策略，包括通过股骨插管优化血管穿刺的技术，例如使用回声引导插管和荧光镜引导。此外，我们将评估专为大口径装置设计的现有血管闭合装置。最后，我们将考虑旨在降低围手术期通路相关出血风险的新药理学策略。