Ultrasonography fails to reduce bleeding or vascular complications for femoral access: JAMA

A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared with radial access. Strategies to make femoral access safer are needed.

A study was conducted to determine whether routinely using ultrasonography guidance for femoral arterial access for coronary angiography/intervention reduces bleeding or vascular complications.

The Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures (UNIVERSAL) randomized clinical trial is a multicenter, prospective, open-label trial of ultrasonography-guided femoral access vs no ultrasonography for coronary angiography or intervention with planned femoral access. Patients were randomized from June 26, 2018, to April 26, 2022. Patients with ST-elevation myocardial infarction were not eligible.

Results:

• A total of 621 patients were randomized at 2 centers in Canada
• The primary outcome occurred in 40 of 311 patients (12.9%) in the ultrasonography group vs 50 of 310 patients (16.1%) without ultrasonography
• The rates of Bleeding Academic Research Consortium 2, 3, or 5 bleeding were 10.0% vs 10.7%
• The rates of major vascular complications were 6.4% vs 9.4%
• Ultrasonography improved first-pass success and reduced the number of arterial puncture attempts and venipuncture with similar times to access
• All prerandomization prespecified subgroups were consistent with the overall finding.

Thus, in this randomized clinical trial, use of ultrasonography for femoral access did not reduce bleeding or vascular complications. However, ultrasonography did reduce the risk of venipuncture and number of attempts. Larger trials may be required to demonstrate additional potential benefits of ultrasonography-guided access.

Reference:

Jolly SS, AlRashidi S, d'Entremont M, et al. Routine Ultrasonography Guidance for Femoral Vascular Access for Cardiac Procedures: The UNIVERSAL Randomized Clinical Trial. JAMA Cardiol. Published online September 18, 2022. doi:10.1001/jamacardio.2022.3399

Keywords:

Jolly SS, AlRashidi S, d'Entremont M, Routine, Ultrasonography, Guidance, Femoral, Vascular, Access, Cardiac, Procedures, JAMA Cardiology