Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta‐analysis

Marquis‐Gravel, Guillaume; Tremblay-Gravel, Maxime; Lévesque, Jonathan; Généreux, Philippe; Schampaert, Erick; Palisaitis, Donald; Doucet, Michel; Charron, Thierry; Terriault, Paul; Tessier, Pierre

doi:10.1111/joic.12492

Cited by 40 publications

(30 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ultrasound guided retrograde puncture was superior to an anatomical landmark approach in pooled results from five RCTs of coronary angiography. 111 Ultrasound guidance leads to fewer attempts (odds ratio [OR] 0.24), reduced risk of venous puncture (OR 0.18), and most importantly, fewer bleeding complications (OR 0.41).…”

Section: Classmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

338

222

View full text Add to dashboard Cite

Section: Classmentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

338

222

View full text Add to dashboard Cite

“…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%

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

View full text Add to dashboard Cite

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.

show abstract

“…The reduction of bleeding event could mainly be attributed to smaller size sheath used in TR‐PCI and the adjunctive use of ultrasound‐guided access may further decrease bleeding complications. Interestingly, ultrasound‐guided access showed decreased risk of bleeding in TF while this was not evident in TR approach . Anticoagulation regimen during PCI is one of the main determinants of bleeding risk.…”

Section: Discussionmentioning

confidence: 97%

“…Interestingly, ultrasound-guided access showed decreased risk of bleeding in TF while this was not evident in TR approach. 34,35 Anticoagulation regimen during PCI is one of the main determinants of bleeding risk. Bivalirudin was associated with less bleeding compared with heparin regardless of glycoprotein IIb/IIIa inhibitor use but at the expense of higher ST risk.…”

Section: Clinical Presentationmentioning

confidence: 99%

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

Ando

Aoi

Ashraf

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives To assess the efficacy and safety of transradial (TR) versus transfemoral (TF) percutaneous coronary intervention (PCI) in left main (LM) lesion. Background TR‐PCI is the preferred approach compared with TF approach because of less bleeding risk. LM‐PCI is often challenging because of the anatomical complexity and uniqueness of supplying a large myocardium territory. We performed a systematic review and meta‐analysis to assess the safety and efficacy of TR‐PCI compared with TF‐PCI of the LM lesions. Methods A comprehensive literature search of PUBMED, EMBASE, and Cochrane database was conducted to identify studies that reported the comparable outcomes between both approaches. Odds ratio (OR) and 95% confidence interval (CI) was calculated using the Mantel–Haenszel method. Results A total of eight studies were included in the quantitative meta‐analysis. TR‐PCI resulted in lower bleeding risk (OR 0.31, 95%CI 0.18–0.52, P < 0.01, I2 = 0%) while maintaining similar procedural success rate, target lesion revascularization, myocardial infarction, stent thrombosis, and all‐cause mortality during the study follow‐up period. Conclusions TR‐PCI may achieve similar efficacy with decreased bleeding risk compared to TF‐PCI in LM lesions. When operator experience and anatomical complexity are favorable, TR approach is an attractive alternative access over TF approach in LM‐PCI.

show abstract

Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta‐analysis

Cited by 40 publications

References 38 publications

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

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

Transradial versus transfemoral percutaneous coronary intervention of left main disease: A systematic review and meta‐analysis of observational studies

Contact Info

Product

Resources

About