Real-Time Ultrasound Guidance Facilitates Femoral Arterial Access and Reduces Vascular Complications

Seto, Arnold H.; Abu‐Fadel, Mazen; Sparling, Jamie L.; Zacharias, Soni; Daly, Timothy S.; Harrison, Alexander T.; Suh, William M.; Vera, Jesús A.; Aston, Christopher E.; Winters, Rex J.; Patel, Pranav; Hennebry, Thomas A.; Kern, Morton J.

doi:10.1016/j.jcin.2010.04.015

Cited by 405 publications

(229 citation statements)

References 22 publications

(30 reference statements)

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“…To avoid post-puncture bifurcation, ultrasound guidance has been reported to be effective. 13,14) However, in our study, recognition of post-bifurcation punctures after the cannula insertion did not have any effect on the rate of complications. Hence, from the viewpoint of convenience, we believe that our angiography technique is sufficiently effective for reducing the complication rate.…”

Section: Discussioncontrasting

confidence: 64%

A Novel Technique of Femoral Artery Angiography for the Detection of Post-bifurcation Puncture and the Avoidance of Complication

Koizumi

Shojima

Dofuku

et al. 2016

JNET

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Objective: Cerebral diagnostic angiography and endovascular surgery are commonly performed via the femoral artery, which is prone to complications. The objective of this study is to describe our approach to achieve femoral access safely.Case Presentations: Between April 2014 and March 2015, we performed femoral angiography from the outer sheath of the intra-arterial cannula prior to the insertion of the sheath. Using those images, we retrospectively divided the puncture status of each patient into four categories: optimal, high-position, low-position, and post-bifurcation punctures.Of the 190 femoral punctures performed during the study period, femoral arteriograms were confirmed in 155 (81.6%) cases. In those cases, optimal, high-position, low-position, and post-bifurcation punctures accounted for 125 (80.6%), 1, 0, and 29 cases, respectively. In other words, post-bifurcation puncture could be overlooked in as many as 29/154 (18.8%) cases without femoral angiography. In the cases of post-bifurcation punctures, large sheath insertion was avoided. Overall, there were no cases of morbidity or mortality related to the puncture. Conclusion:Femoral artery angiography can visualize post-bifurcation punctures, which are not evident upon the usual fluoroscopy-guided femoral punctures. This method represents a safe and effective way to reduce the risk of complications associated with femoral artery punctures in cerebrovascular catheter angiography and neuroendovascular treatments.

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Section: Discussioncontrasting

confidence: 64%

A Novel Technique of Femoral Artery Angiography for the Detection of Post-bifurcation Puncture and the Avoidance of Complication

Koizumi

Shojima

Dofuku

et al. 2016

JNET

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“…However, 4F sheaths were also used, and although the distance of puncture from the femoral head was not reported, retrograde punctures and high CFA bifurcation cases were included, indicating that these were punctures close to the femoral head. In another prospective trial, Gutzeit, et al (17) investigated 100 US-guided direct antegrade SFA accesses, reporting a 15.7% complication rate, including 10.2% pseudoaneurysm formation, which is exceedingly higher than the reported 0.2% incidence of pseudoaneurysm formation during US-guided CFA punctures, as well as results herein presented (6,16,18). Still, hemostasis was again obtained mainly by manual compression (84 cases resulting in 9 pseudoaneurysms), while the Starclose SE® VCD was used in only 14 cases resulting in one pseudoaneurysm formation (17).…”

Section: Discussionsupporting

confidence: 52%

Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

Spiliοpoulos

Kitrou²,

Christeas³

et al. 2016

Diagn Interv Radiol

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“…In a study by Hilty et al [39], which was conducted on patients who were in cardiac arrest, the superior performance of ultrasound-guided insertion was attributed to its ability to allow visualization of the vein even in the absence of a palpable femoral arterial pulse. Use of ultrasound for catheterization of the femoral artery or vein reduces vascular complications because it provides better definition of the local anatomy and decreases the chances of accidental puncture of other vessels [41,42].…”

Section: Femoral Veinmentioning

confidence: 99%

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

et al. 2013

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Vascular access used in the treatment of patients involves central and peripheral vein accesses and arterial accesses. Catheterization of central veins is widely used in clinical practice; it is a necessary part of the treatment of patients in various settings. The most commonly involved vessels are the internal jugular, subclavian, and femoral veins. The mechanical, infectious, and thrombotic complications of central venous catheterization are markedly reduced when the procedure is performed with real-time ultrasound guidance or (to a slightly lesser extent) ultrasound assistance. Ultrasound guidance is also used to create peripheral venous accesses, for catheterization of peripheral veins and for peripheral insertion of central venous catheters. In this setting, it increases the catheterization success rate, especially during difficult procedures (e.g., obese patients, children) and reduces complications such as catheter-related infections and venous thrombosis. Arterial cannulation is used for invasive monitoring of arterial pressure and for access during diagnostic or therapeutic procedures. Ultrasound guidance reduces the risk of catheterization failure and complications. It is especially useful for arterial catheterization procedures performed in the absence of a palpable pulse (e.g., patient in shock, ECMO). Imaging support is being used increasingly to facilitate the creation of vascular accesses under difficult conditions, in part because of the growing use of ultrasonography as a bedside procedure. In clinical settings where patients are becoming increasingly vulnerable as a result of advanced age and/or complex disease, the possibility to reduce the risks associated with these invasive procedures should motivate clinicians to acquire the technical skills needed for routine use of sonographic support during vascular access procedures. Keywords Vascular access Á UltrasoundRiassunto Gli accessi vascolari utilizzati nella cura dei pazienti comprendono gli accessi venosi centrali e periferici e gli accessi arteriosi. L'incannulamento di accessi venosi centrali è manovra largamente diffusa nella pratica clinica e si rende necessaria per la cura dei pazienti in molteplici contesti. I vasi centrali che usualmente vengono incannulati sono la vena giugulare interna, la vena succlavia e la vena femorale. Nell'incannulamento venoso centrale sia l'eco-assistenza che l'eco-guida real time, pur con una leggera superiorità di quest'ultima, riducono drasticamente le complicanze meccaniche, infettive e trombotiche. La guida ecografica viene utilizzata anche per l'accesso venoso periferico, per l'incannulamento di vasi periferici e di vasi centrali a inserzione periferica (PICC). In questo contesto la guida ecografica aumenta il successo della manovra di incannulamento soprattutto in condizioni di difficoltà, come avviene nei pazienti obesi o nei bambini, e diminuisce le complicanze quali le infezioni catetere correlate e le trombosi venose. L'incannulamento arterioso viene utilizzato per il monitoraggio cruent...

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Real-Time Ultrasound Guidance Facilitates Femoral Arterial Access and Reduces Vascular Complications

Cited by 405 publications

References 22 publications

A Novel Technique of Femoral Artery Angiography for the Detection of Post-bifurcation Puncture and the Avoidance of Complication

A Novel Technique of Femoral Artery Angiography for the Detection of Post-bifurcation Puncture and the Avoidance of Complication

Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications

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