The Accuracy and Complications of Femoral Arterial Access Using Combined Real-Time Ultrasound and Fluoroscopy vs. Ultrasound Alone for Coronary Angiography and Percutaneous Coronary Intervention

Background:
To assess the accuracy of common femoral artery (CFA) puncture using two techniques: combination of real-time ultrasound (US) and fluoroscopy versus US alone and examine the differences in procedure-related adverse events.

Methods:
We identified all 274 adult patients who underwent diagnostic or interventional coronary or peripheral procedure via a CFA at a single academic center. The procedures were performed utilizing: (1) ultrasound guidance alone; or (2) ultrasound guidance with fluoroscopic femoral landmarks. Four groups of CFA puncture on angiography and four zones of femoral head on fluoroscopy were identified (Figure 1.A-B).

Results:
Of the 274 patients enrolled in this study, 192 (70%) had CFA puncture using combined real-time US and fluoroscopy and 82 (30%) had US only. The accuracy to obtain vascular access using the combined US and fluoroscopy was 90.1%, but it was 86.5% for the US only group. When utilizing US only, there was higher incidence of puncturing in zone 1 of femoral head, but the combined ultrasound and fluoroscopy had 8% risk for puncturing in zone 5. The rate of any procedure related complication was 2.6%, but no differences were appreciated between US and fluoroscopy vs. US alone. Clinically significant hematoma (>5 cm) developed in 2% of the cohort, but these occurred mainly in patients who received PCI in both imaging techniques.

Conclusions:
The combined use of US and fluoroscopy had the highest success rate to obtain vascular access in Zone 2 of CFA. While higher rate of vascular puncture in Zone 1 of femoral head was observed with use of US only, the rate of complication when utilizing any kind of imaging modality remains very low.