Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial

Nguyen, Phong; Makris, Angela; Hennessy, Annemarie; Jayanti, S.; Wang, Alexandra; Park, Kevin; Chen, Vanessa; Nguyen, Tram; Lo, S.; Xuan, Wei; Leung, Melissa; Juergens, C.

doi:10.4244/eij-d-19-00336

Cited by 54 publications

(53 citation statements)

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“…We included seven trials [7][8][9][10][17][18][19], in which 3180 patients were randomized to UGC (n = 1564) or SA (n = 1616). The detailed study flow diagram is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…The recently published standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF) trial [7] is a factorial study design aiming to compare the effectiveness of trans-radial versus trans-femoral access and standard versus ultrasound-guided arterial access in patients undergoing cardiac catheterization. Of note, trans-radial access was superior to TFA in decreasing the rate of primary end-points including a composite acute catheterization and urgent intervention triage strategy (ACUITY) major bleeding, major adverse cardiac events (death, stroke, myocardial infarction or urgent target lesion revascularization) and vascular complications at 30 days (RR: 0.37, 95% CI: 0.17-0.81; p = 0.013), mostly driven by ACUITY major bleeding (RR: 0.343, 95% CI: 0.123-0.959; p = 0.041).…”

Section: Discussionmentioning

confidence: 99%

“…This meta-analysis presents several limitations. First, most of the studies had a small sample size, and these results are mainly driven by the three largest RCTs [7][8][9] that formed almost 80% of the entire population. Second, outcomes and definitions varied among the studies and only three studies had blinded outcome assessments.…”

Section: Discussionmentioning

confidence: 99%

“…In this scenario, adopting real-time ultrasound-guided cannulation (UGC) of the femoral artery may potentially decrease such adverse events. In recent years, several randomized controlled trials (RCTs) have been published evaluating the efficacy and safety of UGC in patients undergoing percutaneous cardiovascular interventions (PCvI), providing new insights within the context of new technologies and invasive procedures [7][8][9][10]. However, these trials were mostly underpowered to assess major vascular complications as a primary outcome, and the effect of UGC on clinically relevant vascular-access-related complications during femoral artery catheterization remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Sorrentino

Nguyen

Salerno

et al. 2020

JCM

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Background: It is unclear whether or not ultrasound-guided cannulation (UGC) of the femoral artery is superior to the standard approach (SA) in reducing vascular complications and improving access success. Objective: We sought to compare procedural and clinical outcomes of femoral UGC versus SA in patients undergoing percutaneous cardiovascular intervention (PCvI). Methods: We searched EMBASE, MEDLINE, Scopus and web sources for randomized trials comparing UGC versus SA. We estimated risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) for categorical and continuous variables, respectively. Primary efficacy endpoint was the success rate at the first attempt, while secondary efficacy endpoints were access time and number of attempts. Primary safety endpoints were the rates of vascular complications, while secondary endpoints were major bleeding, as well as access site hematoma, venepuncture, pseudoaneurysms and retroperitoneal hematoma. This meta-analysis has been registered on Centre for Open Science (OSF) (osf.io/fy82e). Results: Seven trials were included, randomizing 3180 patients to UGC (n = 1564) or SA (n = 1616). Efficacy between UGC and SA was the main metric assessed in most of the trials, in which one third of the enrolled patients underwent interventional procedures. The success rate of the first attempt was significantly higher with UGC compared to SA, (82.0% vs. 58.7%; RR: 1.36; 95% CI: 1.17 to 1.57; p < 0.0001; I2 = 88%). Time to access and number of attempts were significantly reduced with UGC compared to SA (SMD: −0.19; 95% CI: −0.28 to −0.10; p < 0.0001; I2 = 22%) and (SMD: −0.40; 95% CI: −0.58 to −0.21; p < 0.0001; I2 = 82%), respectively. Compared with SA, use of UGC was associated with a significant reduction in vascular complications (1.3% vs. 3.0%; RR: 0.48; CI 95%: 0.25 to 0.91; p = 0.02; I2 = 0%) and access-site hematoma (1.2% vs. 3.3%; RR: 0.41; CI 95%: 0.20 to 0.83; p = 0.01; I2 = 27%), but there were non-significant differences in major bleeding (0.7% vs. 1.4%; RR: 0.57; CI 95%: 0.24 to 1.32; p = 0.19; I2 = 0%). Rates of venepuncture were lower with UGC (3.6% vs. 12.1%; RR: 0.32; CI 95%: 0.20 to 0.52; p < 0.00001; I2 = 55%). Conclusion: This study, which included all available data to date, demonstrated that, compared to a standard approach, ultrasound-guided cannulation of the femoral artery is associated with lower access-related complications and higher efficacy rates. These results could be of great clinical relevance especially in the femoral cannulation of high risk patients.

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“…We included seven trials [7][8][9][10][17][18][19], in which 3180 patients were randomized to UGC (n = 1564) or SA (n = 1616). The detailed study flow diagram is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Sorrentino

Nguyen

Salerno

et al. 2020

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…of attempts (1.47 vs. 1.9; P<0.0001), and the rate of difficult accesses (4.5% vs. 9.2%; P=0.0007) and improved first-pass access (73% vs. 59.7%; P<0.0001). 31 It would be beneficial to implement the transradial approach more widely in HBR patients requiring complex PCI.…”

Section: Figure 3)mentioning

confidence: 99%

Transradial vs. Transfemoral Percutaneous Coronary Intervention in Patients With or Without High Bleeding Risk Criteria

Yamamoto

Natsuaki

Morimoto

et al. 2020

Circ J

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Routine Ultrasonography Guidance for Femoral Vascular Access for Cardiac Procedures

et al. 2022

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IMPORTANCE A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared with radial access. Strategies to make femoral access safer are needed. OBJECTIVE To determine whether routinely using ultrasonography guidance for femoral arterial access for coronary angiography/intervention reduces bleeding or vascular complications. DESIGN, SETTING, AND PARTICIPANTSThe Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures (UNIVERSAL) randomized clinical trial is a multicenter, prospective, open-label trial of ultrasonography-guided femoral access vs no ultrasonography for coronary angiography or intervention with planned femoral access. Patients were randomized from June 26, 2018, to April 26, 2022. Patients with ST-elevation myocardial infarction were not eligible.INTERVENTIONS Ultrasonography guidance vs no ultrasonography guidance for femoral arterial access on a background of fluoroscopic landmarking. MAIN OUTCOMES AND MEASURESThe primary composite outcome is the composite of major bleeding based on the Bleeding Academic Research Consortium 2, 3, or 5 criteria or major vascular complications within 30 days.RESULTS A total of 621 patients were randomized at 2 centers in Canada (mean [SD] age, 71 [10.24] years; 158 [25.4%] female). The primary outcome occurred in 40 of 311 patients (12.9%) in the ultrasonography group vs 50 of 310 patients (16.1%) without ultrasonography (odds ratio, 0.77 [95% CI, 0.49-1.20]; P = .25). The rates of Bleeding Academic Research Consortium 2, 3, or 5 bleeding were 10.0% (31 of 311) vs 10.7% (33 of 310) (odds ratio, 0.93 [95% CI, 0.55-1.56]; P = .78). The rates of major vascular complications were 6.4% (20 of 311) vs 9.4% (29 of 310) (odds ratio, 0.67 [95% CI, 0.37-1.20]; P = .18). Ultrasonography improved first-pass success (277 of 311 [86.6%] vs 222 of 310 [70.0%]; odds ratio, 2.76 [95% CI, 1.85-4.12]; P < .001) and reduced the number of arterial puncture attempts (mean [SD], 1.2 [0.5] vs 1.4 [0.8]; mean difference, −0.26 [95% CI, −0.37 to −0.16]; P < .001) and venipuncture (10 of 311 [3.1%] vs 37 of 310 [11.7%]; odds ratio, 0.24 [95% CI, 0.12-0.50]; P < .001) with similar times to access (mean [SD], 114 [185] vs 129 [206] seconds; mean difference, −15.1 [95% CI, −45.9 to 15.8]; P = .34). All prerandomization prespecified subgroups were consistent with the overall finding. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, use of ultrasonography for femoral access did not reduce bleeding or vascular complications. However, ultrasonography did reduce the risk of venipuncture and number of attempts. Larger trials may be required to demonstrate additional potential benefits of ultrasonography-guided access.

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Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial

Cited by 54 publications

References 23 publications

Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

Transradial vs. Transfemoral Percutaneous Coronary Intervention in Patients With or Without High Bleeding Risk Criteria

Routine Ultrasonography Guidance for Femoral Vascular Access for Cardiac Procedures

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