Ultrasound-guided Femoral Artery Access for Minimally Invasive Neuro-intervention and Risk Factors for Access Site Hematoma

Abstract

Although ultrasound (US) guidance for venous access is becoming the “standard of care” for preventing access site complications, its feasibility for arterial access has not been fully investigated, especially in the neuro-interventional population. We conducted the first prospective cohort study on US-guided femoral artery access during neuro-interventional procedure. This study included 64 consecutive patients who underwent US-guided femoral artery access through 66 arterial access sites for diagnostic and/or neuro-interventional purposes. The number of attempts required for both the sheath insertion and the success of anterior wall puncture were recorded. In addition, the occurrence of major complications and hematoma formation on the arterial access site examined by US were statistically analyzed. The median number of attempts was 1 (1–2) and first-pass success rate was 63.6%. Anterior wall puncture was achieved in 98.5%. In one case (1.5%), a pseudoaneurysm was observed. In all cases, US clearly depicted a common femoral artery (CFA) and its bifurcation. Post-procedural hematoma was detected in 13 cases (19.7%), most of which were “tiny” or “moderate” in size. Low body mass index and antiplatelet therapy were the independent risk factors for access site hematoma. The US-guided CFA access was feasible even in neuro-interventional procedure. The method was particularly helpful in the patients with un-palpable pulsation of femoral arteries. To prevent arterial access site hematoma, special care should be taken in patients with low body mass index and who are on antiplatelet therapy.

Incidence and predictors of groin complication after cerebral neurointervention procedure: single centre study

“…A study by Kurisu et al about ultrasound guided femoral artery access for minimally invasive neurointervention and risk factors for access site hematoma reported that the number of attempts puncture in first pass success was 63.6%, and it did not contribute significantly to groin hematoma after the procedure with p=0.788, but, when they evaluated the relationship between catheter size and hematoma, they found that catheter size 6 Fr (21.2%) was a risk factor for hematoma formation with p=0.099. 16 This could happen because they also classified hematoma into very tiny with size less than 20 mm, meanwhile we did not use any classification for our hematoma and we only used manual evaluation that was based on qualitative measurement.…”

“…The systolic blood pressure more than 180 before the procedure was about the time more likely to develop groin complications compared to other categories. 16 Meanwhile, patients with chronic hypertension were more adapted than acute hypertension, Dumont reported that chronic hypertensive patients were 60% less likely to have vascular complications. 20 In this study we did not record pre-procedural blood pressure, that might be why we did not have similar results with previous study.…”

“…A study by Kuriso et al showed that the used of anticoagulant therapy had a significant relationship with hematoma formation (p=0.007), and it became the most significant factor besides BMI that were independently at risk for access site hematoma formation with multivariate analysis. 16 The used of anticoagulants caused interference in thrombin-mediated activities and might interfere with wound healing, stall wound progression, and complications after wound healing, including bleeding, excessive wound exudate, and also hematoma. 21 To our knowledge, we were the first to find the incidence rate of hematoma or groin complication after neurointervention procedure and the significant factor associated with it in Indonesia.…”

Endovascular Treatment for a Femoral Arteriovenous Fistula after Removal of a Hemodialysis Catheter

“…An AVF following insertion of a double-catheter is rare but can cause serious problems. We would advocate for routine use of ultrasound-guided arterial punctures to minimise the risk of femoral AVF formation as well as other complications [9].…”

Retroperitoneal Bleeding as a Rare Complication of Femoral Artery Puncture

“…(2018) сообщают, что переход на трансрадиальный доступ позволил достоверно снизить частоту формирования забрюшинных гематом, при этом авторы отмечают, что, по их данным, развитие этого грозного осложнения независимо ассоциируется с 3-кратным увеличением летальности и 5-кратным увеличением частоты развития сердечно-сосудистых осложнений в 30-дневный срок [36]. Другие авторы считают рутинное использование УЗИ-навигации при пункции артерии, использование 21G игл для пункции, а также проведение пункции в «безопасной зоне» достаточными для снижения частоты встречаемости постпункционных проблем [37,38].…”