Figure 2 Basic steps of micropuncture arterial access technique Figure 2 | Basic steps of micropuncture arterial access technique. a | Using fluoroscopy, the mid-femoral head is identified. The arrows show the femoral skin crease. b | A haemostat marks the mid-femoral head, and the local anaesthesia needle is just below the skin surface (arrow). This marker provides some idea of where the micropuncture needle should be introduced into the skin. c | Repeat fluoroscopy when the needle is deep in the subcutaneous tissue, but not yet into the femoral artery, is required to achieve an ideal location of femoral puncture at the level of the mid-femoral head. The arrow shows the tip of the micropuncture needle. d | Contrast injection through the micropuncture needle shows the level of needle entry in the common femoral artery (CFA; arrows shows the level of CFA bifurcation). e | A 0.018 inch guidewire is advanced into the femoral artery. The arrow shows the guidewire exit point from the needle tip, which is the site of needle entry into the CFA lumen. f | Angiography via a 6 French sheath confirms the arterial entry site. The arrows show the takeoff of the inferior epigastric artery and the CFA. The sheath entry is above the mid-femoral head, but clearly inferior to the inferior sweep of the inferior epigastric artery (upper arrow) and above the bifurcation (lower arrow). Reprinted from Cilingiroglu, M.et al. Fluoroscopically-guided micropuncture femoral artery access for large-caliber sheath insertion. J. Invasive Cardiol. 23 (4), 157–161 © (2011), with permission from HMP Communications. Reprinted from Cilingiroglu, M. et al. Fluoroscopically-guided micropuncture femoral artery access for large-caliber sheath insertion. J. Invasive Cardiol. 23 (4), 157–161 © (2011), with permission from HMP Communications. Rao, S. V. & Stone, G. W. (2016) Arterial access and arteriotomy site closure devices Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.133