0:01

So our first learning objective, defining

0:03

vascular access and identifying important

0:05

equipment used during vascular access.

0:09

The first question is, what is vascular access?

0:12

It is the percutaneous, so through

0:15

the skin, cannulation of an anatomical

0:18

point within the vasculature.

0:20

We're dealing with arteries or veins, vasculature.

0:23

Obviously, our focus today is on the artery,

0:26

but you can get access to a vein, which will be

0:29

another module, which we'll sort of take in full.

0:32

In order to get access into the blood

0:34

vessel, it takes some time and some

0:37

technique and some considerations, which

0:39

we will outline in our conversations today.

0:41

But what I want to sort of share with you

0:43

is, once you are in the artery, you can do

0:47

everything that interventional radiologists do.

0:50

You can place this being a fenestrated endograft

0:54

that we placed when I was in fellowship.

0:57

This being a patient with hepatocellular carcinoma

1:00

that ended up coming to me for radioembolization.

1:04

This being a patient who had a large left

1:07

thigh malformation that we ended up embolizing.

1:11

This being a patient who had a previous stent

1:13

in his superficial femoral artery placed by

1:17

a cardiologist at an outside hospital, then

1:19

presented to us with resumption of his treatment.

1:22

One to two block claudication.

1:24

So once you're in the vessel and you're able

1:26

to successfully achieve that real access

1:29

and closure, you can essentially accomplish

1:33

the great things that interventionalists

1:35

can perform intravascularly.

1:38

So why is proper vascular access so important?

1:40

Well, we touched on it before, but it

1:43

is the foundational practice, the first

1:45

step that is necessary for us to perform

1:47

any of the great clinical interventions.

1:49

Procedures that we as interventionists

1:51

perform on a daily basis.

1:53

And without it, the safe, successful

1:56

vascular access, no procedure can proceed.

1:59

You know, it's like being able to sort of work

2:01

with a pilot who can fly a plane at 10,000 feet

2:04

but can't get it there or cannot land it.

2:07

So this is a fundamental skill

2:10

that needs to be mastered.

2:11

It is the thing that, once you master it,

2:14

you are able to do and proceed to the next.

2:17

So let's look at these tools that I

2:19

consider to be sort of the staples, the most

2:21

important sort of rubrics as we prepare.

2:25

There's the needle.

2:26

This allows us to sort of puncture the

2:28

skin to get access into the blood vessel,

2:30

the artery in this particular case.

2:32

There's the wire.

2:33

It is the railroad that we move through

2:37

the vessel to guide and to serve as a

2:39

platform for other interventional equipment.

2:41

Then there's the sheath.

2:43

It's sort of the doorway.

2:44

It's the doorway to the blood vessel that

2:46

sort of hangs out right from the point.

2:48

The dermatotomy to the arteriotomy in this case.

2:51

That allows us to move a catheter in

2:54

and out, and then there are the catheters.

2:57

The hollow tubes that are curved and shaped in

2:59

order to get into the nooks and crannies and

3:02

the vasculature that we all choose to get into.