Management of femoral large-bore access and closure during microaxial flow pump-supported interventions

Microaxial flow pump (mAFP) is increasingly employed for hemodynamic support in both cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCI). However, its implantation requires large-bore arterial access, which carries a substantial risk of vascular complications, translating into higher morbidity, mortality, and healthcare costs. Optimizing outcomes depends on safe vascular access and effective closure strategies. Ultrasound- and angiography-guided puncture, often complemented by advanced imaging, enhance the safety of femoral access. In the HR-PCI setting, pre-closure techniques are generally feasible and advisable as a prophylactic strategy. Conversely, in CS patients, where pre-closure is frequently not achievable, post-closure techniques during mAFP removal play a pivotal role. This review provides a contemporary, practical framework to manage femoral large-bore access and closure in patients undergoing mechanical circulatory support with mAFP.