Femoral Access is Safer Under Ultrasound Guidance. Complications of Femoral Artery Access

Transcription

1 Femoral Access is Safer Under Ultrasound Guidance Jennifer Baker, MD November 9, 2018 Complications of Femoral Artery Access Hematomas: 2-12% 2 Pseudoaneurysms 0.2-9% 1 Arteriovenous fistulas % 2 2 1

2 Steps to Decrease Iatrogenic Complications of Femoral Access -Single anterior wall stick in the CFA that is below the inguinal ligament and above the CFA bifurcation -Cannulate over the middle 1/3 of the femoral head -Access above the inguinal ligament retroperitoneal hemorrhage -Access below the CFA bifurcation PSA, AVF Blind Approach Our patient the pin cushion, poke until you get a gusher. 2

3 A Randomized trial assessing the value of US-Guided Puncture of the Femoral Artery for Interventional Investigations pts with normal AC parameters, randomized into 2 groups - The mean number of attempts for vessel puncture and total vessel access time - No significant statistical difference between the groups - : Femoral Arterial Access with Ultrasound Trial (FAUST) 4 Procedural Outcomes 3

4 Femoral Arterial Access with Ultrasound Trial 4 Clinical Outcomes Routine use of US Guidance in Femoral Arterial Access for PVI Decreases Groin Hematoma Rates 5 - The Vascular Study Group of New England (VSGNE) evaluated the effect of routine vs selective use of ultrasound guidance on groin hematoma rates after PVI in a retrospective study. - The overall post-procedural groin hematoma rate after PVI was 4.5% and the rate of combined moderate and major hematoma was 0.8% - Routine ultrasound guidance was observed to be protective against hematoma development in the following circumstances: - Pt age > 80 yo, BMI > 30, and sheath size > 6F 4

5 Routine Use of US Guidance in Femoral Arterial Access for PVI Decreases Groin Hematoma Rates in High-Volume Surgeons. 6 - The Vascular Quality Initiative (VQI) sought to confirm the findings of the VSGNE and evaluate the effects of US usage and interventionalist volume on hematoma rates following PVI. - Hematoma rates not only between routine and selective US users were compared but also broken down into subgroups based on interventionalist volume US Guidance versus Anatomical Landmark Approach for Femoral Artery Access in Coronary Angiography: A Randomized Controlled Trial and Meta-Analysis. 7 Bleeding Events Puncture Attempts Venipunctures 5

6 Let s See Those Ears! Comparison of US Guidance and Conventional Method for Common Femoral Artery Cannulation: A Prospective Study of 939 Patients 8 6

7 US-Guided Catheterization of the Femoral Artery: A Systemic Review and Meta-Analysis of Randomized Controlled Trials 9 Conclusion Ultrasound guided femoral access can be safer and improve patient comfort -Increase ease of access in patients with a weak pulse and large leg circumference. -Increases successful cannulation in high CFA bifurcations -In some studies, reduce the risk of hematoma or major complications 7

8 References 1. Stone PA, Campbell JE, AbuRahma AF. Femoral pseudoaneurysms after percutaneous access. J Vasc Surg 2014;60(5): Bhatty S, Cooke R, Shetty R, Jovin I. Femoral vascular access-site complications in the cardiac catheterization laboratory:diasnosis and management. Interv. Cardiol 2011;3(4): Oliver D, Teichgraeber U, Podrabsky P, et. al. A randomized trial assessing the value of ultrasound-guided puncture of the femoral artery for interventional investigations. The International Journal of Cardiovascular Imaging 2004;20: Seto AH, Abu-Fadel MS, Sparling JM, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC: Cardiovasc Interv. 2010;3: Kalish J, Eslami M, Gillespie D, et al. Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates. J Vasc Surg 2015;61: Inagaki E, Farber A, Siracuse J, et al. Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates in high-volume surgeons. Ann Vasc Surg 2018;51: Marquis-Gravel G, Tremblay-Gravel M, Levesque J, et al. Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: a randomized controlled trial and a meta-analysis. J Interven Cardiol. 2018;31: Katırcıbaşı MT, Gunes H, Aykan AC, Aksu E, and Ozgul S. Comparison of ultrasound guidance and conventional method for common femoral artery cannulation: a prospective study of 939 patients. Acta Cardiol Sin 2018;34: Sobolev M, Slovut D, Chang AL, Shiloh AL, Eisen LA. Ultrasound-guided catheterization of the femoral artery: a systematic review and meta-analysis of randomized controlled trials. The Journal of Invasive Cardiology 2015;27(7): Thank You! 8