Management of Patients with Difficult Vascular Access Issues

Given the high association of cardiac and renal disease, it is imperative that considerations for future vascular access are taken into consideration at the time of any procedure. In this chapter we discuss the high incidence of central stenosis associated with cardiac instrumentation such as central access for line placement and the need for placement of pacer wires. All of this type of instrumentation may make future vascular access problematic. We present several unique ways to gain access in this challenging patient population.