Ultrasonography-guided antegrade common femoral artery approach: Factors associated with access time

Abstract

Introduction: The aim of this study was to evaluate the feasibility and safety of ultrasonography-guided antegrade common femoral artery puncture and subsequent superficial femoral artery access without the aid of fluoroscopy. Factors that could affect access time were also assessed. Methods: A total of 294 cases from 218 consecutive patients (163 men, 55 women; mean age: 66.9 ± 12.7 years) who underwent lower extremity endovascular procedures were retrospectively evaluated. The time between the injection of local anesthetic and the insertion of the microsheath into the superficial femoral artery was measured. The common femoral artery diameter, cutis thickness, distance between arterial puncture site and common femoral artery bifurcation, degree of common femoral artery calcification, body mass index, and history of previous access were investigated to assess their relationship with access time. Furthermore, all cases were assessed with ultrasonography for access-site complications before discharge. Results: Technical success was achieved in 293 of 294 procedures (99.7%). The mean time for superficial femoral artery access was 1.9 ± 0.8 min (range, 0.7–3.7 min). Additional fluoroscopic guidance was needed in one case. There were moderately positive correlations of body mass index ( r = 0.75; p < 0.001) and cutis thickness ( r = 0.58; p < 0.001) with access time. The other variables failed to reveal significant correlations with access time. Five groin hematomas occurred after percutaneous transluminal angioplasty. Complications such as pseudoaneurysm, arteriovenous fistula, or retroperitoneal hematoma were not observed. Conclusion: Antegrade common femoral artery puncture with subsequent superficial femoral artery access conducted solely under ultrasonography guidance was feasible and safe. In addition, the antegrade access time showed positive correlations with body mass index and cutis thickness.

Meta-analysis of ultrasound-guided and traditional femoral artery puncture

“…The reasons for this include the higher rate of success on first attempt, less damage to blood vessels, and the easy-to-apply modified Seldinger method by which it is easier to puncture the anterior surface. A comparison of the previous fluoroscopy-guided antegrade (25) and ultrasound-guided antegrade (26) revealed that ultrasound-guided antegrade is less likely to cause hematoma, as it may be easier with ultrasound to successfully avoid puncturing the posterior wall of the artery and causing minor damage to the blood vessels (26). Therefore, it is considered that there is no significant difference in the rate of hematoma between the ultrasound-guided puncture method and the traditional method in the antegrade puncture group patients and the traditional puncture group patients, which may be related to the smaller sample size.…”

Controversies and challenges of coil embolization for intracranial aneurysm in a continuous-flow LVAD implanted patient: A case report

“…Neurosurgeons should not hesitate to use US guidance. [10] e perioperative imaging modality is another pitfall since MRI does not apply to patients with CF-LVAD. Physicians should consider whether an MRI is necessary and how to follow-up with the patient.…”

Choosing the appropriate catheter and wire in peripheral intervention

“…The approach begins with an antegrade puncture below the inguinal ligament. In several conditions, such as the presence of scar tissue, obesity, or a previously failed puncture, ultrasound can help decrease the procedure duration and increase the success rate 22 .…”