Abstract 16045: Fluoroless Arterial Access and Closure for VT Ablation: Feasibility and Safety of an Ultrasound Guided Landmark Approach

Abstract

Introduction: Ultrasound (US) guided access has become the gold standard of care for central access cannulation. The FAUST1 trial demonstrated that routine real-time US guidance was equivalent to fluoroscopic guidance but improved common femoral artery (CFA) access success and reduced complications in patients with high CFA bifurcations. The utilization of non radiation imaging modalities over the past decade has resulted in significantly reduced radiation exposure and orthopedic problems associated with prolonged electrophysiology procedures2. Hypothesis: Why do many operators still use fluoroscopy and arteriograms in addition to ultrasound guided access? Methods: A prospective single center multi-operator study was performed on patients undergoing premature ventricular contractions (PVC) or Ventricular Tachycardia (VT) ablation with arterial access. CFA access was obtained using a US guided landmark identification protocol. US probe is utilized in short and long access to identify upper and lower borders of the femoral head in relation to the CFA bifurcation. CFA access is then obtained with a modified Seldinger approach within femoral head landmarks. After arterial sheath insertion, the artery is again evaluated for closure appropriateness, assessed by absence of arterial calcifications within 5mm of arrteriotomy or stenosis <5mm in diameter. Results: 20 consecutive patients undergoing PVC or PVT ablation were included. All patients underwent US only guided access to the right common femoral artery. All patients underwent successful closure with a hemostasis device. There were no vascular complications. Conclusions: Real-time US only guided CFA access is feasible and safe. Appropriate utilization of US is sufficient to avoid intravenous contrast and radiation exposure without increased complication rate.