Femoral vein access

Bleeding is a problem in femoral (thigh) vascular access in cardiac procedure – while radial (wrist) vascular access results in substantially less bleeding.* There are times, though, when femoral access is still required, such as when radial access is blocked or too small.

Using ultrasound – or ultrasonography (US) – guidance is a technique sometimes added to the standard fluoroscopy (moving Xray images) to help guide the interventional cardiologist during femoral access.

US has no risks and is widely available; however, currently, less than a third of femoral-access cases have included US guidance. Results have been mixed in earlier trials around the effect of bleeding and vascular complications in patients.

In the UNIVERSAL trial, PHRI Scientist Sanjit Jolly and team found that use of US for femoral access did not reduce bleeding or vascular complications – but it did facilitate access.

There was a reduced risk of puncturing veins, and fewer attempts were required by the interventional cardiologist – so that there were more ”first passes’ successful in the procedure using US-guided femoral access.

Results (download Jolly’s slides – PDF) were presented today by Jolly at TCT Conference 2022, with simultaneous publication in JAMA Cardiology (full text).

In UNIVERSAL, 621 patients were randomized at 2 centres in Canada; the trial design was published in CJC Open (full text). Each operator was approved for the trial after performing 10 cases demonstrating the required skills for US-guided femoral access.

Updated meta-analyses – 9 randomized clinical trials included with a total of 4410 patients – support the benefits of US-guided femoral access, Jolly notes. “Larger trials may be required to demonstrate additional potential benefits of ultrasonography-guided access.”

* PHRI’s landmark RIVAL trial, led by Jolly (Lancet, 2011), showed the relative safety of radial compared to femoral access.

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