Ultrasound-Guided Catheterization of the Femoral Artery

A Systematic Review and Meta-analysis of Randomized Controlled Trials

Maria Sobolev, MD; David P. Slovut, MD, PhD; Alfredo Lee Chang, MD; Ariel L. Shiloh, MD; Lewis A. Eisen, MD

Disclosures

J Invasive Cardiol. 2015;27(7):318-323. 

In This Article

Abstract and Introduction

Abstract

Objectives. The goal of this meta-analysis was to determine the utility of real-time two-dimensional (2D) ultrasound guidance for femoral artery catheterization.

Background. Despite the shift toward establishing vascular access via the radial artery rather than the femoral artery, femoral artery cannulation is still frequent in cardiac catheterization. Since vascular complications related to femoral artery cannulation can be quite devastating, preventing these complications is vital.

Methods. A comprehensive literature search of Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials was performed. Additionally, five years of conference abstracts from critical care, interventional radiology, vascular surgery, and cardiology were reviewed. Two independent reviewers identified prospective, randomized controlled trials comparing ultrasound guidance with traditional palpation techniques of femoral artery catheterization (with or without fluoroscopy). Data were extracted on study design, study size, operator and patient characteristics, complication rates, first-pass success, procedure time, and number of attempts.

Results. Four trials with a total of 1422 subjects were included in the review, with 703 subjects in the palpation group and 719 subjects in the ultrasound-guided group. Compared with traditional methods, ultrasound guidance for femoral artery catheterization was associated with 49% reduction in overall complications, including hematoma and accidental venipuncture (relative risk, 0.51; 95% confidence interval, 0.28–0.91). It was also associated with 42% improvement in the likelihood of first-attempt success (relative risk, 1.42; 95% confidence interval, 1.01–2.00).

Conclusions. The use of real-time 2D ultrasound guidance for femoral artery catheterization decreases life-threatening vascular complications and improves first-pass success rate.

Introduction

Femoral artery catheterization is a common procedure in various specialties and especially in interventional cardiology.[1] Despite the growing trend for radial artery access in cardiac catheterization, factors such as complex percutaneous coronary interventions (PCIs), operator and center expertise, procedural volume, longer access time, as well as operator radiation exposure, have swayed many interventionalists to continue to use the conventional femoral artery approach for cardiac catheterization.[2–5] Clearly, whichever approach is utilized, it is important that vascular access be obtained in the safest way possible. Vascular complications such as retroperitoneal bleeding, loss of distal pulse requiring vascular surgery, and even seemingly minor complications like hematoma, pseudoaneurysm, and arteriovenous fistula can be devastating and contribute to periprocedure morbidity and mortality. Minimizing access-site complications has been associated with improved outcomes.[6]

While femoral artery cardiac catheterization has been performed for several decades, there is no general agreement about the safest and most effective method for obtaining access. Many operators use palpation techniques with fluoroscopy or micropuncture with fluoroscopy. Ultrasound guidance, while seldom used in the past for femoral artery access, is growing in popularity among operators due to its accepted use in central venous catheterization (CVC) and radial artery catheterization.[7,8] Given the lack of consensus to the optimal approach in femoral artery catheterization, we conducted a meta-analysis to systematically review the literature to determine the benefits of real-time ultrasound guidance.

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