Transcatheter interventions have transformed the treatment of structural heart diseases for patients who are ineligible or at a prohibitive risk for surgery. Among these procedures, the transfemoral approach remains the most widely utilized vascular access route, owing to its ease of access and high success rate. However, meticulous imaging-guided preprocedural planning is essential to minimize complications and improve clinical outcomes. This chapter presents a comprehensive review of transfemoral access assessment for large-bore transcatheter structural heart interventions, highlighting key anatomical landmarks, imaging modalities, technical considerations, and adjunctive tools for safe arterial access. Additionally, it discusses the prevention and management of vascular access complications following transfemoral interventions, which are associated with substantial morbidity and mortality. The identification of patient- and procedure-related risk factors, combined with the implementation of evidence-based strategies to enhance access-site safety, including the tailored use of vascular closure techniques and devices, offers structured guidance for achieving procedural safety and efficiency in contemporary structural heart interventions.