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

• Published in: Journal of interventional cardiology Vol. 31; no. 4; pp. 496 - 503
• Main Authors: Marquis‐Gravel, Guillaume, Tremblay‐Gravel, Maxime, Lévesque, Jonathan, Généreux, Philippe, Schampaert, Erick, Palisaitis, Donald, Doucet, Michel, Charron, Thierry, Terriault, Paul, Tessier, Pierre
• Format: Journal Article
• Language: English
• Published: United States Hindawi Limited 01.08.2018
• Subjects: Aged; Angiography; arterial access; Bleeding; Blood Loss, Surgical - statistics & numerical data; Cannulation; Catheterization, Peripheral - adverse effects; Catheterization, Peripheral - methods; Clinical trials; coronary angiography; Coronary Angiography - adverse effects; Coronary Angiography - methods; Female; Femoral artery; Femoral Artery - diagnostic imaging; Femoral Artery - surgery; Femur; Humans; Male; Medical imaging; Meta-analysis; Middle Aged; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional - methods; Ultrasound; percutaneous coronary intervention; femoral artery; coronary angiography; ultrasound; arterial access
• ISSN: 0896-4327; 1540-8183
• DOI: 10.1111/joic.12492

Objectives The objective was to assess the effect of ultrasound (US)‐guidance compared to the anatomical landmark (AL) approach in patients requiring femoral artery (FA) access for coronary angiography/percutaneous coronary interventions (PCI). Background US‐guidance has been proposed as a strategy to optimize FA access, potentially leading to decreased vascular complications. Methods Patients requiring FA access for coronary angiography/PCI were randomized to the US‐guided or AL approaches. The primary endpoint was a composite of immediate procedural vascular outcomes, and access‐site outcomes at day one. Results were subsequently pooled in a study‐level meta‐analysis of randomized trials comparing US‐guided FA access to another strategy. Results A total of 129 patients were randomized (64 US‐guided group; 65 AL group). The primary endpoint occurred in 30 patients (47%) with US, and in 39 patients (62%) with AL (P = 0.09). Four additional studies met the inclusion criteria and were included in the meta‐analysis (1553 patients). Following data pooling, bleeding events (OR = 0.41; 95%CI 0.20‐0.83; P = 0.01), venipunctures (OR = 0.18; 95%CI: 0.11‐0.29; P < 0.0001), and multiple puncture attempts (OR = 0.24; 95%CI: 0.19‐0.31; P < 0.0001) were significantly improved with US‐guidance, but not successful common FA cannulation (OR = 0.84; 95%CI: 0.60‐1.17; P = 0.29). Conclusion Our study did not show significant benefits for the use of US to guide arterial femoral access compared to the anatomical landmark approach, but pooled analysis of five randomized trials showed decreased rates of bleeding events and venipunctures, and improved first‐pass success. The clinical impact of these findings is uncertain, and do not warrant a systematic use of US‐guidance in this clinical setting.