Ultrasound‑guided venous access facilitated by the Valsalva maneuver during invasive electrophysiological procedures

Abstract

BACKGROUND Data on the feasibility of an ultrasound-guided venous access (USGVA) for catheter ablation (CA) and electrophysiological studies (EPS) in large cohorts are scarce. The impact of the Valsalva maneuver (VM), which can increase the diameter of the femoral vein (FV), on the USGVA is unknown. AIMS The study aimed to determine the impact of the VM on FV diameters during establishing the USGVA and overall safety and effectiveness profile of the USGVA in a large cohort. METHODS Consecutive patients undergoing CA and / or EPS with the USGVA were included, and those with anatomical landmark-guided VA were recruited as controls. In a subgroup of USGVA patients, a VM-facilitated FV puncture was performed. The measurements obtained before and during the VM were used to calculate the estimated access area (EAA) of the FV. RESULTS A total of 1564 ultrasound-guided FV accesses in 876 patients and 172 FV accesses in 105 patients in the anatomical-VA group were performed. We observed no major complications associated with the USGVA. Minor adverse events related with VA were less common in the USGVA group than in controls (1.5% vs 6.7%, respectively; P = 0.001), resulting in a 4-fold decrease in VA-related complications. In 204 consecutive patients who underwent the VM-facilitated USGVA, the FV diameters increased during VM in both vertical (mean [SD], 10.1 [3] mm vs 14.4 [3.2] mm; P <0.001) and horizontal axes (10.6 [2.9] mm vs 14.5 [3.2] mm; P <0.001). This led to the mean (SD) increase in EAA of 38%: from 0.8 (0.2) cm 2 at baseline to 1.1 (0.2) cm 2 during VM (P <0.001). CONCLUSIONS The USGVA for EPS and / or CA is feasible. Complication rates for the USGVA are low and result in minor events. The Valsalva maneuver is a simple way to remarkably increase the femoral vein EAA and it can be helpful in performing the USGVA in difficult cases.

Ablation for paroxysmal atrial fibrillation—real-life results from a middle-volume electrophysiology laboratory

“…Two neurological complications occurred in patients with many risk factors (CHA 2 DS 2 Vasc = 5) or sub-optimal ACT during initial part of the procedure (maximal ACT of only 275 s was achieved). The rate of local complications was similar before and after introduction of USG-guided approach which shows that there is a room for improvement in our EP laboratory because data from literature suggest reduction of local complications when USG is used [ 19 ].…”

Ultrasound-guided versus anatomic landmark-guided vascular access in cardiac electrophysiology procedures: a systematic review and meta-analysis

“…Finally, 9 studies (1 RCT and 8 observational) were included in the meta-analysis. [6][7][8][9][10][11][12][13][14] The basic study characteristics are summarized in Table 1. Five studies included only AF catheter ablation procedures while 4 studies included all EP procedures.…”

Ultrasound-guided versus anatomic landmark-guided vascular access in cardiac electrophysiology procedures: A systematic review and meta-analysis

“…Six congress abstracts, 1 single-arm study, and 1 study not meeting the outcome definitions were excluded. Finally, 9 studies were included in the meta-analysis: 1 RCT and 8 observational cohort studies (3 prospective, 3 retrospective, 2 not specified) [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ]. The basic study characteristics are summarized in Table 1 .…”

“…Futyma et al. assessed the effectiveness of this technique during US-guided femoral venipunctures in EP procedures [ 15 ]. No significant differences in the rates of minor or major adverse events between the VM-supported and standard methods were observed, probably due to the low number of events.…”