Fourteen years ago, we initiated the planning for what would become the Femoral Artery Ultrasound Trial (FAUST) . Even at that time, the field of cardiology was late in studying the value of ultrasound guidance (USG) for vascular access. USG by then had already become the standard of care to guide central venous access after 20 years of favorable if small randomized trials. USG was recommended by national guidelines for reducing the time to access, the number of attempts, and the risk of complications . With the fresh eyes of a trainee (AS) and junior attending (MAF), we wondered why cardiologists would not consider USG for their femoral arterial access, when the risks for bleeding and vascular complications were high in the setting of anticoagulation for PCI.