Ultrasound guidance for femoral venous access in electrophysiology procedures—systematic review and meta-analysis

Abstract

Purpose The most common complications of electrophysiology (EP) procedures are related to vascular access. Our study aims to conduct a meta-analysis comparing ultrasound (US)-guided vs. palpation-based technique for femoral venous access in EP procedures. Methods Electronic databases were searched and systematically reviewed for studies comparing femoral vein puncture with/ without US in EP procedures. The primary outcome was the rate of major vascular complications; secondary outcomes were minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time. Predefined subgroup analysis was conducted separately for patients undergoing pulmonary vein isolation procedure (PVI). A random-effects model was used to derive risk ratios (RR) with 95% confidence interval (CI). Results Nine studies involving 8232 patients met our inclusion criteria. Compared with the standard technique, the use of US reduced major vascular complications (from 2.01 to 0.71%, p < 0.0001). The rate of minor vascular complications (RR = 0.30, 95% CI, 0.14-0.62, p = 0.001) and inadvertent artery puncture were lower with US-guided puncture (RR = 0.31, 95% CI, 0.17-0.58, p = 0.0003). Puncture time was shorter (mean difference = − 92.1 s, 95% CI, − 142.12-− 42.07 s, p = 0.0003) and postprocedural groin pain was less frequent (RR = 0.57, 95% CI, 0.41-0.79, p = 0.0008) in the US group. Subgroup analysis of patients undergoing PVI also showed significant reduction of major vascular complications (RR = 0.27, 95% CI, 0.12-0.64, p = 0.003) and inadvertent artery puncture (RR = 0.35, 95% CI, 0.21-0.59, p < 0.0001). Conclusion Real-time US-guidance of femoral vein puncture in EP procedures is beneficial: it reduces major and minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time.

Gender differences in major vascular complications of catheter ablation for atrial fibrillation

“…Another larger meta‐analysis demonstrated that the use of US‐guidance for vascular access in electrophysiology procedures reduces the risk of MVC by 71% compared with the standard anatomical approach 25 . Moreover US guidance significantly reduced puncture time and inadvertent arterial puncture 25 . Our results confirmed the benefit of US‐guidance in males only.…”

“…In a meta‐analysis by Sobolev et al, 24 the use of real‐time US‐guidance decreased access‐related bleeding and life‐threatening vascular complications, though the number needed to treat was quite large. Another larger meta‐analysis demonstrated that the use of US‐guidance for vascular access in electrophysiology procedures reduces the risk of MVC by 71% compared with the standard anatomical approach 25 . Moreover US guidance significantly reduced puncture time and inadvertent arterial puncture 25 .…”

Femoral vascular complications after catheter ablation in the current era: The utility of computed tomography imaging

“…A superior approach might increase the risk of retroperitoneal bleeding. A real‐time ultrasound‐guided venipuncture may be useful and recommended to prevent these vascular complications 10,11 . A meta‐analysis investigating the utility of ultrasound‐guided femoral venous access showed that this technique reduced major and minor vascular complications, inadvertent artery punctures, postprocedural groin pain, and puncture time as compared with the palpation‐based technique in electrophysiological procedures 10 .…”

“…A real‐time ultrasound‐guided venipuncture may be useful and recommended to prevent these vascular complications 10,11 . A meta‐analysis investigating the utility of ultrasound‐guided femoral venous access showed that this technique reduced major and minor vascular complications, inadvertent artery punctures, postprocedural groin pain, and puncture time as compared with the palpation‐based technique in electrophysiological procedures 10 . This technique also increased the first‐pass and overall success rates and reduced the risk of complications of central venous catheterization through the subclavian and femoral routes, as well as arterial and difficult peripheral venous access 11 .…”

Outcomes of Uninterrupted vs Interrupted Periprocedural Direct Oral Anticoagulants in Atrial Fibrillation Ablation: A Meta-Analysis

“…A recently published meta-analysis found that the rate of vascular complications in electrophysiology procedures-and thus, major and minor bleeding-can be reduced by using ultrasound-guided femoral access. 30…”