A Prospective Randomized Study Comparing Ultrasound versus Fluoroscopic Guided Femoral Arterial Access in Non-Cardiac Vascular Patients
Patrick A Stone1, John E Campbell2, Zachary AbuRahma3, Stephanie N Thompson3
1Vanderbilt University Medical Center, Nashville, TN;2West Virginia University - Charleston Division, Charleston, WV;3Charleston Area Medical Center, Charleston, WV
The aim of our prospective, randomized study was to compare the procedural outcomes and complication rates of ultrasound (US) guided common femoral artery (CFA) access to fluoroscopic guidance in non-cardiac procedures. Randomized studies comparing CFA access techniques and resultant complications have been almost exclusively performed in patients undergoing cardiac procedures. Differences between peripheral vascular disease (PVD) and coronary artery disease patient populations and percutaneous techniques warrant US-guided femoral cannulation to be examined independently in PVD procedures.
631 patients undergoing femoral access for non-cardiac diagnostic or interventional procedures were randomized 1:1 to receive either fluoroscopic or US guided access. The primary end point of the study was successful CFA cannulation. Secondary end points included first pass success rate, time to sheath insertion, and accidental venipunctures rate. Both short (24 hours) and mid-term (30-90 days post procedure) access complications were assessed by midlevel practitioners blinded to patient randomization group.
Successful CFA cannulation occurred in 88% of US guided procedures compared to 81% of fluoroscopy guided access (p=0.02). US guidance associated with increased rates of first-attempt success (78% vs. 46%, p<0.001), fewer inadvertent venipunctures (2% vs. 10 %, p<0.001), and decreased median time to cannulation (median time, 1.3
vs. 1.7 minutes, p <0.001) compared to fluoroscopy. When access was performed by vascular surgery trainees (residents and fellows), US guidance retained superior rates of successful CFA cannulation compared to fluoroscopy guided access (n=298, 92% vs. 83%, p=0.04). Trainees’ time to achieve CFA cannulation was similar to attendings’ when using US guidance (1.3 vs. 1.3 minutes, p = 0.77), however with fluoroscopy, trainees’ times were significantly longer than those of attendings (2.2 vs 1.5 minutes, p =0.001). Rates of complications did not differ at 24 hours (1.5% vs 1.9, p= 0.90) or 30-90 days (5% vs. 2.2%, p = 0.24) between the two guidance techniques.
In comparison to fluoroscopy, US guided CFA cannulation had a higher rate of success, faster cannulation, and less venipunctures in the absence of increased complications. Furthermore, US guidance may be especially beneficial in the training of vascular residents and fellows.
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