Article Details

The management of peripheral accesses becomes more and more crucial in coronary procedures interventions that need large-bore guiding catheters and many tools are now available to help increasing the success of the delivering materials through complex anatomies. The radial approach reduces vascular complications but leads to some limitations in the size of the catheters. The sheathless technique with the Railway (Cordis) was developed in the transradial access in order to reduce this size limitation, with the development of a specific dilator that can easily navigate through tortuous vessels. We report a case where this specific Railway dilator was used not in a transradial access but in a transfemoral access, allowing the positioning of an Arrow-Flex Sheath introducer. We describe the technical challenge encountered in the management of a difficult femoral access needing specific tools to be adapted to various situations. Our option brings together techniques and materials combined with newer tools and access that open up many more possibilities.