Ultrasound-guided Femoral Access Research Articles

Ultrasound-Guided Femoral Access in Patients With Vascular Closure Devices: Insights From the Randomized UNIVERSAL Trial

Ultrasound-Guided Femoral Access in Patients With Vascular Closure Devices: Insights From the Randomized UNIVERSAL Trial

Routine Ultrasound-Guided Femoral Access and Use of One Vascular Closure Device for Femoral Hemostasis After TAVR: Feasibility And Safety

Routine Ultrasound-Guided Femoral Access and Use of One Vascular Closure Device for Femoral Hemostasis After TAVR: Feasibility And Safety

Ultrasound-Guided Femoral Vascular Access for Percutaneous Coronary and Structural Interventions.

Radial access has largely substituted femoral access for coronary interventions. Nevertheless, the femoral artery remains indispensable for gaining access to structural and complex percutaneous coronary interventions such as transcatheter aortic valve implantation and chronic total occlusion interventions, respectively. Ultrasound-guided femoral puncture is a broadly available, inexpensive, and relatively easy-to-learn technique. According to the existing evidence, ultrasound guidance for gaining femoral access has improved the effectiveness and safety of the technique. In the present paper, we sought to review the current literature in order to provide the reader with up-to-date data regarding the benefits of ultrasound-guided femoral access compared with the conventional technique as well as describing the state-of-the-art technique for gaining femoral access under ultrasound guidance.

CRT-100.01 Ultrasound-Guided Femoral Access in Patients With Vascular Closure Devices: Insights From the Randomized UNIVERSAL Trial

CRT-100.01 Ultrasound-Guided Femoral Access in Patients With Vascular Closure Devices: Insights From the Randomized UNIVERSAL Trial

Single center experience of transcatheter aortic valve replacement with a simplified operative protocol

Objective: To summarize the single center experience of transcatheter aortic valve replacement (TAVR) with a simplified operative protocol. Methods: Consecutive patients who underwent transfemoral TAVR (TF-TAVR) from July 2020 to December 2020 in Fuwai Hospital were retrospectively analyzed. We compared the baseline characteristic, procedure information, 30-day follow-up outcomes of the patients who underwent TF-TAVR without the simplified operative protocol (routine group) or with the simplified operative protocol (simplified protocol group). Results: 93 patients were collected, 42 patients belonging to routine group, 51 patients belonging to simplified protocol group. In simplified protocol group, there were 51 patients planned to use ultrasound-guided femoral access puncture, procedure was successful in all 51 patients (100%). There were 49 patients planned to use the radial artery as the secondary access, procedure was successful in 45 patients (92%). There were 48 patients planned to use the strategy of avoidance of urinary catheter, this strategy was achieved in 35 patients (73%). There were 12 patients planned to use the left ventricular guidewire to pace, procedure was successful in 11 patients (92%). There were no differences in baseline characteristics, major clinical endpoints and 30-day follow-up outcomes between the two groups. Meanwhile, the procedure time ((62.5±17.9)min vs. (78.3±16.7)min, P<0.001), operation room time ((133.7±25.1)min vs. (159.2±42.6)min, P<0.001), X-ray exposure time ((17.2±6.5)min vs. (20.2±7.7)min, P=0.027) were significantly shorten in simplified protocol group compared with the routine group. Conclusion: Our study results indicate that the simplified operative protocol of TF-TAVR is as effective and safe as the routine operative protocol, meanwhile using the simplified operative protocol can significantly increase the operative efficiency of TF-TAVR.

Outcomes After Routine Ultrasound Usage in Percutaneous Endovascular Aortic Aneurysm Repair

Previously, endovascular aneurysm repair (EVAR) with failed percutaneous access was associated with higher rates of cardiac complications, longer operative times, greater estimated blood loss, and a prolonged length of stay. We evaluated the national trends and benefit of routine ultrasound-guided femoral access in percutaneous EVAR (PEVAR) in the Vascular Quality Initiative.

To Ultrasound or not to Ultrasound: A REBOA Femoral Access Analysis from the ABOTrauma and AORTA Registries

IntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardizedadjunct in the management of non-compressible hemorrhage. Ultrasound (US)-guided femoralaccess has been taught as the best practice for femoral artery cannulation. However, there is lackof evidence to support its use in patients in extremis with severe hemorrhage. We hypothesizethat no differences in outcome will exist between US-guided in comparison to blindpercutaneous or cutdown access methods.MethodsThis was an international, multicenter retrospective review of all patients managed with REBOAfrom the ABOTrauma Registry and the AORTA database. REBOA characteristics and outcomeswere compared among puncture access methods. Significance was set at P &amp;lt; 0.05.ResultsThe cohort included 523 patients, primarily male (74%), blunt injured (77%) with median age 40(27 – 58), ISS 34 (25 – 45). Percutaneous using external landmarks/palpation was the mostcommon femoral puncture method (53%) used followed by US-guided (27.9%). There was nosignificant difference in overall complication rates (37.4% vs 34.9%; P = 0.615) or mortality(47.8% vs 50.3%; P = 0.599) between percutaneous and US-guided methods; however, access bycutdown was significantly associated with emergency department (ED) mortality (P = 0.004), 24hour mortality (P = 0.002), and in-hospital mortality (P = 0.007).ConclusionsIn patients with severe hemorrhage in need of REBOA placement, the percutaneous approachusing anatomic landmarks and palpation, when compared to ultrasound-guided femoral access,&#x0D; was used more frequently without an increase in complications, access attempts, or mortality.Surgical cutdown was associated with highest ED, 24-hour, and in-hospital mortality.&#x0D; Level of Evidence: Level III; Prognostic

The Learning Curves for Transradial and Ultrasound-Guided Arterial Access: An Analysis of the SURF Trial

Historically, coronary angiography and percutaneous coronary intervention involved accessing the femoral artery via palpation. However, recently there has been a trend towards using a transradial approach and ultrasound guidance for arterial access. Studies have shown that these techniques respectively improve major bleeding rates and access outcomes. There have been no studies conducted that assess the time it takes to train operators to attain proficiency. This sub-analysis of the Standard versus Ultrasound-guided Radial and Femoral access in coronary angiography and intervention (SURF) trial aims to assess the number of procedures required to attain proficiency in ultrasound-guided transradial and transfemoral access. The SURF trial randomised 1,388 patients undergoing coronary angiography and/or percutaneous coronary intervention into standard or ultrasound-guidance and radial or femoral access in a 2×2 factorial design. Operators who participated in this trial were required to have performed at least 50 standard and 10 ultrasound-guided punctures for each of transradial and transfemoral access. Cases were then chronologically ordered and stratified into groups of five, from which the primary endpoint measured was a progression in mean access time and first-pass success rates. Across all operators, there was a reduction in mean access time between procedures one to five and six to 10 with ultrasound-guided femoral punctures (60.5 secs-51.5 secs, p=0.029) and between procedures 11 to 15 and 16 to 20 ultrasound-guided radial punctures (74s to 62.5 secs, p=0.082). This trend was more obvious in trainees, with significant reductions in mean access time between procedures one to five and six to 10 from 73.5 to 53.5 seconds (p<0.001) for ultrasound-guided femoral access and from 99.5 seconds to 60 seconds (p=0.024) for ultrasound-guided radial access. There were no trends with standard transradial access. The numbers required to attain competency in ultrasound-guided femoral and radial access are 15 and 25 punctures, respectively. Fifty (50) punctures appear adequate for proficiency in a standard transradial approach. These numbers are useful in incorporating into training program for advanced trainees and interventionalists.

To Ultrasound or not to Ultrasound: A REBOA Femoral Access Analysis from the ABOTrauma and AORTA Registries

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct in the management of non-compressible hemorrhage. Ultrasound (US)-guided femoral access has been taught as the best practice for femoral artery cannulation. However, there is a lack of evidence to support its use in patients in extremis with severe hemorrhage. We hypothesize that no differences in outcome will exist between US-guided and to blind percutaneous or cutdown access methods.Methods: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. REBOA characteristics and outcomes were compared among puncture access methods. Significance was set at P &lt; 0.05.Results: The cohort included 523 patients, primarily male (74%), blunt injured (77%), with median age 40 (27–58), and an Injury Severity Score of 34 (25–45). Percutaneous using external landmarks/palpation was the most common femoral puncture method (53%) used followed by US-guided (27.9%). There was no significant difference in overall complication rates (37.4% vs 34.9%; P = 0.615) or mortality (47.8% vs 50.3%; P = 0.599) between percutaneous and US-guided methods; however, access by cutdown was significantly associated with emergency department (ED) mortality (P = 0.004), 24 hour mortality (P = 0.002), and in-hospital mortality (P = 0.007).Conclusions: In patients with severe hemorrhage in need of REBOA placement, the percutaneous approach using anatomic landmarks and palpation, when compared with US-guided femoral access, was used more frequently without an increase in complications, access attempts, or mortality.

Regional Variation in Usage of Ultrasound-Guided Femoral Access in the Vascular Quality Initiative

Access site complications are among the most common complications following peripheral vascular interventions. Previous studies have demonstrated a reduced rate of complications with ultrasound-guided vascular access (UGVA). The objective of this study is to evaluate the regional use of UGVA within the Vascular Quality Initiative (VQI). The VQI peripheral intervention module between 2010 and 2018 was evaluated. Regional ID was used to compare distribution of ultrasound usage. Regions were grouped into terciles based on the rate of ultrasound use. Patients were categorized based on type of access. Primary outcome was use of ultrasound across regions. Secondary outcomes were access site complications. Over 43,000 cases across the 18 VQI regions were evaluated. The average rate of ultrasound usage was 71% across the regions with a wide variation (range 38-97%). There is a significant difference in utilization among the top third (87%), middle third (79%), and bottom third (58%) (P<0.001). Average sheath size was similar across all 3 groups. A higher use of ultrasound-guided access was associated with significantly fewer access site complications (top third 1.96% vs. bottom third 3.04%, P<0.001), the most significant of which was a decreased rate of access site hematoma (top third 1.37% vs. bottom third 2.35%, P<0.001). This is the first study to evaluate ultrasound-guided access across VQI regions. Our results demonstrate that despite strong evidence supporting the utilization of UGVA, there remains a wide variation in ultrasound usage across VQI regions. This is also the first study to show that the prevalence of ultrasound use in peripheral vascular interventions (PVI) is inversely related to access site complications. Given all of the data supporting the usage of UGVA across numerous specialties, our findings encourage the consideration of an ultrasound-first approach for vascular access in PVI and the implementation of targeted strategies and evidence-based guidelines to enhance UGVA utilization in PVI.

Same-day discharge in selected patients undergoing atrial fibrillation ablation.

Atrial fibrillation (AF) ablation is a complex procedure, generally requiring at least one overnight hospital stay. We investigated the safety and feasibility of early mobilization and same-day discharge following streamlined peri-ablation management for AF. From 2014, we offered same-day discharge to selected patients who underwent uncomplicated AF ablation on the morning lists, with ultrasound-guided femoral access, uninterrupted warfarin or minimal interruption in novel oral anticoagulants, and reversal of intraprocedural heparin with protamine. Patients were discharged 6-8h postprocedure and offered access to a dedicated nurse helpline. Of 1599 AF ablation cases performed from April 2014 to March 2017, 811 (50.7%) were performed on the morning lists and 169/811 (20.8%) were discharged on the same day. Excluding 26 research cases, 1/143 (0.7%) had transient right phrenic nerve palsy and five (3.5%) cases experienced minor problems that did not preclude same-day discharge; three (2.1%) needed rehospitalization postdischarge: one for pericarditic chest pain and two for nausea/vomiting. Compared to 642 overnight cases, day-case procedures were shorter, more likely to be redos, to be performed under sedation rather than general anesthesia, and less likely to involve linear lesions and electrical cardioversion. There were no significant differences in patient age, gender, body mass index, CHA2 DS2 -VASc, in preprocedural anticoagulation regimen (warfarin vs novel anticoagulants vs no anticoagulation) and in choice of ablation method (cryoballoon vs radiofrequency). Selective same-day discharge after AF ablation is safe and feasible using a streamlined peri-procedural care protocol. Wider adoption can potentially reduce health-care costs while improving patient experience.

Ultrasound-Guided Femoral Access in Patients with Large Thigh Circumference: Analysis from the Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) Trial

Ultrasound-Guided Femoral Access in Patients with Large Thigh Circumference: Analysis from the Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) Trial

Ultrasound-Guided Access Improves Rate of Access-Related Complications for Totally Percutaneous Aortic Aneurysm Repair

Previous experience with totally percutaneous aortic aneurysm repair has identified morbid obesity and larger sheath sizes (> or =20F) as complicating factors for percutaneous access closure. We sought to evaluate the impact of ultrasound-guided femoral access on rates of technical success, conversion to open femoral repair, and access-related complications. A retrospective review of a prospectively maintained database was performed. All consecutive patients undergoing totally percutaneous closure of large-bore-sheath (>12F) access sites with a suture-mediated closure device were included. The cohort was stratified into two groups by access technique, standard percutaneous femoral access, and ultrasound-guided femoral access. Patient variables were evaluated, and outcome measures included technical success, requirement for conversion to open repair, and access-related complications. Recorded conversions only included those related to access closure technique. During the study period, 88 consecutive patients underwent percutaneous closure of 152 large-bore access sites after endovascular aneurysm repair. There was no difference in the proportion of morbidly obese patients (body mass index >35 kg/m(2)) between the two cohorts. Access-related complications were significantly reduced in the group undergoing ultrasound-guided access. Despite the lower complication profile with ultrasound guidance, 24 sites (41%) had sheath sizes > or =20F compared to only 21 sites (24%) in the standard access group (p<0.05). Evaluating conversions and technical success of percutaneous closure, a significant benefit was identified for sheath sizes > or =20F (p<0.05). Upon comparing the two cohorts, operative time continued to decrease from 154 (+/-64) to 101 (+/-56) min after the addition of ultrasound guidance for access (p<0.05). The addition of ultrasound-guided femoral access to totally percutaneous aortic aneurysm repair continues to increase the technical success rate for vessel closure and has a clinically profound impact on access-related complications. This technical adjunct appears to have the largest impact on patients requiring larger sheath sizes.