Ultrasound guided transfemoral access may increase safety during coronary procedures

Cardiac catheterization is an important modality in assessing and treating coronary artery disease. In the past years, trans-femoral access (TFA) is the benchmark for coronary intervention recently published evidence favours transradial access (TRA).

The femoral artery will still be used in a considerate proportion of patients undergoing complex Percutaneous intervention (PCI), especially in PCI of chronic total occlusions (CTO). Ultrasound-guided puncture of the femoral artery may reduce clinically relevant access site complications, but robust evidence is lacking up to date.

A recent study in Eurointervention journal, compared ultrasound (US)-guided transfemoral access (TFA) versus non-US-guided TFA from randomised data in an individual participant-level data (IPD) meta-analysis and found that in patients undergoing coronary procedures by US guided TFA, was efficient in decreasing the composite outcome of major vascular complications or bleeding and may be especially helpful when using vascular closure devices.

Researchers conducted a systematic review and an IPD meta-analysis of all randomised controlled trials comparing US-guided versus non-US-guided TFA for coronary procedures. They performed a one-stage mixed-model meta-analysis using the intention-to-treat population from included trials. The primary outcome was a composite of major vascular complications or major bleeding within 30 days.

The key findings of the study are

• A total of 2,441 participants (1,208 US-guided, 1,233 non-US-guided) from 4 randomised clinical trials were included.

• The mean age was 65.5 years, 27.0% were female, and 34.5% underwent a percutaneous coronary intervention.

• The incidence of major vascular complications or major bleeding (34/1,208 [2.8%] vs 55/1,233 [4.5%]) was lower in the US-guided TFA group.

• In the prespecified subgroup of participants who received a vascular closure device, those randomised to US-guided TFA experienced a reduction in the primary outcome (2.1% vs 5.6%), while no benefit for US guidance was observed in the subgroup without vascular closure devices (4.1% vs 3.3%).

Researchers concluded that “In participants undergoing coronary procedures by TFA, US guidance decreased the composite outcome of major vascular complications or bleeding and may be especially helpful when using vascular closure devices.”

Reference: Marc-André d'Entremont1,2,3, MD, MPH; Sulaiman Alrashidi3, MD; Arnold H. Seto et al; Ultrasound guidance for transfemoral access in coronary procedures: an individual participant-level data metaanalysis from the femoral ultrasound trialist collaboration; Eurointervention,