Since the first femoral access was described by Sven Ivar Seldinger in the 1950s, direct percutaneous arterial and venous approach definitely became the first option in the most of vascular procedures 1. In fact, endovascular interventions have gained enormous traction over the last twenty years and have nowadays become the first-line approach for treatment of many cardiovascular diseases.

Safe and reliable arterial (or venous) access remains the first necessary step for any endovascular interventions, thereby making the issue of access site-related complications still a pressing clinical concern. The choice and the approach to the access site depend on patients’ characteristics and the device diameter. Common femoral access is the preferred route for aortic and cardiac procedures thanks to the often-adequate caliper and the superficial course. Prior to the introduction of vascular closure devices (VCD), manual compression has been used to achieve hemostasis and it is still considered a useful alternative where closure devices are contraindicated or when the operator does not wish to leave an implant behind. On the other hand, surgical cutdown of femoral vessels should be considered in patients presenting a hostile access or an intraoperative access complication 2. Access-site complications (ASC) are often multifactorial with potential contributions from several conditions such as the anatomical characteristics of target vessel, the technique of initial puncture, the need of antithrombotic therapy, the design of the devices and the choice of VCD.

Vascular ASC may not only represent a serious clinical scenario, but they also contribute to increased length of stay and resources utilization, thereby increasing overall costs of treatment. Aim of this review is to report the incidence of potentially limb-threating and/or life-threatening groin complications after percutaneous vascular procedures, their diagnosis and available treatments according to the latest available literature.