Abstract
Percutaneous femoral arterial access is daily practice in a variety of medical specialties and enables physicians worldwide to perform endovascular interventions. The reported incidence of percutaneous femoral arterial access complications is 3–18% and often results from suboptimal puncture location due to insufficient visualization of the target vessel. The purpose of this proof-of-concept study was to evaluate the feasibility and the positional error of a mixed-reality (MR)-assisted puncture of the common femoral artery in a phantom model using a commercially available navigation system. In total, 15 MR-assisted punctures were performed. Cone-beam computed tomography angiography (CTA) was used following each puncture to allow quantification of positional error of needle placements in the axial and sagittal planes. Technical success was achieved in 14/15 cases (93.3%) with a median axial positional error of 1.0 mm (IQR 1.3) and a median sagittal positional error of 1.1 mm (IQR 1.6). The median duration of the registration process and needle insertion was 2 min (IQR 1.0). MR-assisted puncture of the common femoral artery is feasible with acceptable positional errors in a phantom model. Future studies should aim to measure and reduce the positional error resulting from MR registration.
Highlights
Percutaneous puncture of the common femoral artery (CFA) is a frequently used technique to gain arterial vascular access and is applied in a variety of medical specialties such as vascular surgery, cardiology, interventional radiology, and neuroradiology
Technical success was achieved in 14/15 cases (93.3%) with a median axial positional error of 1.0 mm (IQR 1.3) and a median sagittal positional error of 1.1 mm (IQR 1.6)
MR-assisted puncture of the common femoral artery is feasible with acceptable positional errors in a phantom model
Summary
Percutaneous puncture of the common femoral artery (CFA) is a frequently used technique to gain arterial vascular access and is applied in a variety of medical specialties such as vascular surgery, cardiology, interventional radiology, and neuroradiology. The technique of femoral arterial puncture has changed in recent decades. The use of sonography has reduced the complication rate after femoral arterial access, there are still relevant puncture-associated complications in 3–18% of cases today [1,2]. Complications during vascular arterial access mainly arise from suboptimal localization of the puncture site, in addition to the quality of the targeted vessel (diameter, calcification). Inadvertent puncture of the superficial femoral or profound femoral arteries can result in false aneurysms, local dissections with subsequent lower limb ischemia or bleeding complications [2,3]. Arterial puncture of severely calcified vessel areas can lead to local vascular injury and failure of vascular closure devices, which often leads to open surgical conversion to control resulting bleeding complications. Optimal visualization of vascular anatomy is crucial to perform safe femoral arterial access [3,7]
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