This research review article from Circulation: Cardiovascular Interventions focuses on managing large-bore vascular access (≥12 French) during transfemoral procedures, such as heart interventions and electrophysiology.  The authors explore optimal puncture techniques, including ultrasound guidance, and various hemostasis strategies, comparing suture-based and plug-based vascular closure devices (VCDs).  Management of VCD failures and venous access complications are also discussed, outlining bail-out strategies and alternative closure methods. The article aims to minimize vascular complications and improve patient outcomes by optimizing large-bore access management from puncture to sheath removal.