LAUSR

Femoral arterial access is fundamental to interventional cardiology, especially for complex procedures that require large‐bore devices. However, vascular complications arising from suboptimal puncture techniques highlight the need for meticulous practice. This article presents a systematic, ultrasound‐guided approach for achieving an optimal common femoral artery (CFA) puncture, defined by five key criteria: access within the CFA, anterior wall‐only penetration, centralized lumen entry, puncture above the femoral head, and entry into a healthy arterial segment. We detail a six‐step protocol incorporating ultrasound guidance throughout: (1) identification of the CFA and femoral vein; (2) delineation of CFA boundaries; (3) localization of the femoral head; (4) determination of the optimal puncture site; (5) real‐time needle tracking and precise CFA puncture; and (6) confirmation of correct guidewire insertion. This protocol enhances both the safety and reproducibility of the procedure. Although there is a significant learning curve, proficiency with this method aims to enable rapid, consistent, and low‐complication vascular access. The article offers practical recommendations for implementation in the catheterization laboratory—including equipment selection and team training—and reviews current literature supporting the efficacy of ultrasound in minimizing access‐related complications.