Vascular access complications constitute the majority of complications, with an incidence as high as 13%, and include groin hematoma, retroperitoneal bleeding, femoral pseudo aneurysm, and arteriovenous fistula. Strategies to reduce vascular access complications include using a small (21-gauge) needle and ultrasound guidance to obtain vascular access and eliminating the use of femoral arterial access. Use of the femoral artery increases the risk of complications, especially if the puncture is made too far below or above the inguinal ligament and anticoagulation is used.