scholarly journals Standard Versus Ultrasound-Guided Cannulation of the Femoral Artery in Patients Undergoing Invasive Procedures: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 9 (3) ◽  
pp. 677 ◽  
Author(s):  
Sabato Sorrentino ◽  
Phong Nguyen ◽  
Nadia Salerno ◽  
Alberto Polimeni ◽  
Jolanda Sabatino ◽  
...  
Keyword(s):  
Success Rate ◽  
Major Bleeding ◽  
Femoral Artery ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Standard Approach ◽  
Access Time ◽  
Continuous Variables ◽  
Ultrasound Guided ◽  
Access Site

Background: It is unclear whether or not ultrasound-guided cannulation (UGC) of the femoral artery is superior to the standard approach (SA) in reducing vascular complications and improving access success. Objective: We sought to compare procedural and clinical outcomes of femoral UGC versus SA in patients undergoing percutaneous cardiovascular intervention (PCvI). Methods: We searched EMBASE, MEDLINE, Scopus and web sources for randomized trials comparing UGC versus SA. We estimated risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) for categorical and continuous variables, respectively. Primary efficacy endpoint was the success rate at the first attempt, while secondary efficacy endpoints were access time and number of attempts. Primary safety endpoints were the rates of vascular complications, while secondary endpoints were major bleeding, as well as access site hematoma, venepuncture, pseudoaneurysms and retroperitoneal hematoma. This meta-analysis has been registered on Centre for Open Science (OSF) (osf.io/fy82e). Results: Seven trials were included, randomizing 3180 patients to UGC (n = 1564) or SA (n = 1616). Efficacy between UGC and SA was the main metric assessed in most of the trials, in which one third of the enrolled patients underwent interventional procedures. The success rate of the first attempt was significantly higher with UGC compared to SA, (82.0% vs. 58.7%; RR: 1.36; 95% CI: 1.17 to 1.57; p < 0.0001; I2 = 88%). Time to access and number of attempts were significantly reduced with UGC compared to SA (SMD: −0.19; 95% CI: −0.28 to −0.10; p < 0.0001; I2 = 22%) and (SMD: −0.40; 95% CI: −0.58 to −0.21; p < 0.0001; I2 = 82%), respectively. Compared with SA, use of UGC was associated with a significant reduction in vascular complications (1.3% vs. 3.0%; RR: 0.48; CI 95%: 0.25 to 0.91; p = 0.02; I2 = 0%) and access-site hematoma (1.2% vs. 3.3%; RR: 0.41; CI 95%: 0.20 to 0.83; p = 0.01; I2 = 27%), but there were non-significant differences in major bleeding (0.7% vs. 1.4%; RR: 0.57; CI 95%: 0.24 to 1.32; p = 0.19; I2 = 0%). Rates of venepuncture were lower with UGC (3.6% vs. 12.1%; RR: 0.32; CI 95%: 0.20 to 0.52; p < 0.00001; I2 = 55%). Conclusion: This study, which included all available data to date, demonstrated that, compared to a standard approach, ultrasound-guided cannulation of the femoral artery is associated with lower access-related complications and higher efficacy rates. These results could be of great clinical relevance especially in the femoral cannulation of high risk patients.

scholarly journals Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral Transcatheter Aortic Valve Replacement Access: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Rafail A. Kotronias ◽  
Jonathan J.H. Bray ◽  
Skanda Rajasundaram ◽  
Flavien Vincent ◽  
Cedric Delhaye ◽  
...  
Keyword(s):  
Systematic Review ◽  
Transcatheter Aortic Valve Replacement ◽  
Ultrasound Guidance ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Bleeding Complications ◽  
Ultrasound Guided ◽  
Access Site ◽  
Transcatheter Aortic Valve ◽  
Life Threatening

Background: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. Methods: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. Results: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively). Conclusions: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42020218259.

Comparison of ultrasound-guided femoral artery cannulation versus palpation technique in neonates undergoing cardiac surgery

2021 ◽  
pp. 112972982110233
Author(s):  
Fikret Salık ◽  
Mustafa Bıçak
Keyword(s):  
Cardiac Surgery ◽  
Success Rate ◽  
Femoral Artery ◽  
Access Time ◽  
Ultrasound Guided ◽  
Cost Analyses ◽  
Artery Cannulation ◽  
The Cost ◽  
Ultrasound Group

Objectives: Palpation technique for femoral artery cannulation can be very difficult, especially in neonates. In this study, we evaluated whether ultrasound-guided cannulation of the femoral artery is superior to palpation technique in neonates undergoing cardiac surgery. Methods: Forty neonates undergoing cardiac surgery were prospectively randomized into two groups (Ultrasound group and Palpation group). Access time, number of attempts, number of successful cannulations on first attempt, success rate, number of cannulas used, inadvertent access, and complications were compared between the two groups. Cost analyses of the cannulation were performed in two groups. Results: In the ultrasound group, access time for femoral artery cannulation was shorter (6.4 ± 3.0 and 10.2 ± 4.4, p = 0.003) and the number of attempts (1.4 ± 0.6 and 2.3 ± 0.8, p < 0.001) was lower compared to the palpation group. The number of successful cannulations on first-attempt (15 (75%) and 5 (25%), p = 0.002) and the success rate (95% (19) and 60% (12), p = 0.008) were higher in the ultrasound group. The number of cannulas used in the ultrasound group was less than the palpation group ( p = 0.001). The cost of intervention was higher in the palpation group compared to the ultrasound group ( p = 0.048). Conclusions: The ultrasound-guided cannulation of the femoral artery in neonates is superior to the palpation technique based on the increased of the number of successful first-attempt cannulation and success rate, and the reducing of the access time, number of attempts, number of cannulas used, and cost of cannulation.

Abstract 14648: Gender Differences in Procedural Complications Associated With Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-analysis of 244,353 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Martin L Campbell ◽  
John Larson ◽  
Talha Farid ◽  
Stacy Westerman ◽  
Michael S Lloyd ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Gender Gap ◽  
Major Bleeding ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Increased Risk ◽  
Procedural Complications

Introduction: Women undergoing atrial fibrillation catheter ablation (AFCA) have higher rates of vascular complications and major bleeding. However, studies have been underpowered to detect differences in rare complications such as stroke/transient ischemic attack (TIA) and procedural mortality. Methods: We performed a systematic review of databases (PubMed, World of Science, Embase) to identify studies published since 2010 reporting AFCA complications by gender. Six complications of interest were: 1) vascular/groin complications; 2) pericardial effusion/tamponade; 3) stroke/TIA; 4) permanent phrenic nerve injury; 5) major bleeding & 6) procedural mortality. For meta-analysis, random effects models were used when heterogeneity between studies was ≥ 50% (vascular complications, major bleeding) and fixed effects models for other endpoints. Results: Of 5716 citations, 19 studies met inclusion criteria, comprising 244,353 patients undergoing AFCA, of whom 33% were women. Women were older (65.3 ± 11.2 vs. 60.4 ± 13.2 years), more likely hypertensive (60.6 vs. 55.5%) and diabetic (18.3 vs. 16.5%) and had higher CHA 2 DS 2 -VASc scores (3.0 ± 1.8 vs. 1.4 ± 1.4) (p<0.0001 for all comparisons). The rates of all 6 complications were significantly higher in women (Table). However, despite statistically significant differences, the overall incidences of major complications were very low in both genders: stroke/TIA (women 0.51 vs. men 0.39%) and procedural mortality (women 0.25 vs. men 0.18%). Conclusion: Women experience significantly higher rates of AFCA complications. However, the incidence of major procedural complications is very low in both genders. The higher rate of complications in women may be partially attributable to older age and a higher prevalence of comorbidities at the time of ablation. More detailed studies are needed to better define the mechanisms of increased risk in women and to identify strategies for closing the gender gap.

scholarly journals Safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture: A meta-analysis

2018 ◽  
Vol 46 (7) ◽  
pp. 2587-2594 ◽  
Author(s):  
Shuai Miao ◽  
Xiuli Wang ◽  
Lan Zou ◽  
Ye Zhao ◽  
Guanglei Wang ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Success Rate ◽  
Internal Jugular Vein ◽  
Randomized Clinical Trials ◽  
Jugular Vein ◽  
Meta Analysis ◽  
Short Axis ◽  
Ultrasound Guided ◽  
Safety And Efficacy ◽  
First Pass

Objective This meta-analysis was performed to evaluate the safety and efficacy of the oblique-axis plane in ultrasound-guided internal jugular vein puncture. Methods We searched Embase, PubMed, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure for relevant randomized clinical trials comparing the oblique axis with the short axis in ultrasound-guided internal jugular vein puncture. Results Five randomized clinical trials were included in this meta-analysis. The pooled meta-analysis showed that the incidence of arterial puncture in the oblique-axis group was significantly lower than that in the short-axis group. No significant difference was found in the first-pass success rate between the oblique-axis group and short-axis group. Additionally, there were no significant differences in the puncture success rate or number of attempts required between the two groups. Conclusion Ultrasound-guided internal jugular vein puncture using the oblique-axis plane reduced the risk of arterial puncture, but no difference was found in the first-pass success rate, puncture success rate, or number of attempts required.

scholarly journals Comparative effectiveness of ultrasound-guided and anatomic landmark percutaneous dilatational tracheostomy: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258972
Author(s):  
Kun-Te Lin ◽  
Yung-Shuo Kao ◽  
Chun-Wen Chiu ◽  
Chi-Hsien Lin ◽  
Chu-Chung Chou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Percutaneous Dilatational Tracheostomy ◽  
Controlled Study ◽  
Procedure Time ◽  
Ultrasound Guided ◽  
Bleeding Rate ◽  
First Pass ◽  
Major Bleeding Rate

Introduction Ultrasound-guided tracheostomy (UGT) and bronchoscope-guided tracheostomy (BGT) have been well compared. However, the differences in benefits between UGT and landmark tracheostomy (LT) have not been addressed and, in particular, lack a detailed meta-analysis. We aimed to compare the first-pass success, complication rate, major bleeding rate, and tracheostomy procedure time between UGT and LT. Methods In a systematic review, relevant databases were searched for studies comparing UGT with LT in intubated patients. The primary outcome was the odds ratio (OR) of first-pass success. The secondary outcomes were the OR of complications, OR of major bleeding, and standardized mean difference (SMD) of the total tracheostomy procedure time. Results The meta-analysis included three randomized controlled studies (RCTs) and one nonrandomized controlled study (NRS), comprising 474 patients in total. Compared with LT, UGT increased first-pass success (OR: 4.287; 95% confidence interval [CI]: 2.308 to 7.964) and decreased complications (OR: 0.422; 95% CI: 0.249 to 0.718). However, compared with LT, UGT did not significantly reduce major bleeding (OR: 0.374; 95% CI: 0.112 to 1.251) or the total tracheostomy placement time (SMD: -0.335; 95% CI: -0.842 to 0.172). Conclusions Compared with LT, real-time UGT increases first-pass success and decreases complications. However, UGT was not associated with a significant reduction in the major bleeding rate. The total tracheostomy placement time comparison between UGI and LT was inconclusive.

scholarly journals Ultrasound guided femoral artery cannulation: A key point for security

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Niño Claudia ◽  
◽  
Useche Nicolas ◽  
Amaya-Zuñiga William ◽  
◽  
...  
Keyword(s):  
Success Rate ◽  
Femoral Artery ◽  
Arterial Cannulation ◽  
Ultrasound Guided ◽  
Artery Cannulation ◽  
Ultrasound Guide ◽  
Meta Analyses

Some meta-analyses have shown the broad benefits of the ultrasound visualization for arterial cannulation, such as the increases of the first-attempt success rate, mean attempts, meantime, and reduction of hematoma incidence. The advantages over the palpation technique, promote the inclusion of ultrasound guide as part of the recommendation for arterial cannulation [1].

scholarly journals Comparison of short and long axis ultrasound-guided approaches to internal jugular vein puncture: a meta-analysis

2019 ◽  
Vol 47 (9) ◽  
pp. 4069-4082 ◽  
Author(s):  
Jian Zhang ◽  
Xiaohan Wang ◽  
Shuai Miao ◽  
Mengzhu Shi ◽  
Guanglei Wang ◽  
...  
Keyword(s):  
Success Rate ◽  
Internal Jugular Vein ◽  
Sequential Analysis ◽  
Jugular Vein ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Ultrasound Guided ◽  
Dichotomous Data ◽  
Standard Mean Difference

Objective To compare short-axis versus long-axis plane for ultrasound-guided internal jugular vein puncture. Methods PubMed, Embase, Cochrane Library and CNKI databases were searched for randomized controlled trials, published to 1 June 2019, that compared short- versus long-axis plane in ultrasound-guided internal jugular vein puncture. Statistical analyses were performed using RevMan software, version 5.3. Statistical results are presented as risk ratio (RR) (95% confidence interval [CI]) for dichotomous data and standard mean difference (SMD) (95% CI) for continuous data. Results Ten studies fulfilled the inclusion criteria. Analyses of pooled results showed no statistically significant differences in arterial puncture incidence between the two planes (RR 0.73 [95% CI 0.38, 1.39]). First-pass success rate (RR 1.08 [95% CI 0.95, 1.22]), total success rate (RR 1.00 [95% CI 0.99, 1.02]) and number of attempts required (SMD –0.09 [95% CI –0.37, 0.18]) were also similar between the two approaches. Trial sequential analysis indicated that the available evidence was insufficient to detect potential differences between the two techniques. Conclusions There is insufficient data for an evidence-based choice of either short- or long-axis plane in ultrasound-guided internal jugular vein puncture.

TRIACCESS study: randomized comparison between radial, femoral and transpedal access for for percutanous supertfitial femoral artery angioplasty

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Ruzsa ◽  
A Csavajda ◽  
M Deak ◽  
P Sotonyi ◽  
O.F Bertrand ◽  
...  
Keyword(s):  
Success Rate ◽  
Femoral Artery ◽  
Complication Rate ◽  
Randomized Study ◽  
Technical Success ◽  
Access Site ◽  
Femoral Access ◽  
X Ray ◽  
Technical Success Rate ◽  
Access Site Complication

Abstract Background Traditional access for the treatment of femoral artery lesions is the femoral artery (FA) approach, but radial (RA) and pedal access (PA) is an alternative access site. The aim of the study was to compare the success rate, complication rate of different access sites for the treatment of superfitial artery stenosis in a randomized study Methods 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral stenosis, via RA, FA and PA. Primary endpoint: technical success, rate of major and minor access site complications. Secondary endpoints: major adverse events (MAE), procedural factors, cross-over rate, and duration of hospitalization. Results Technical success was achieved in 96.6%, 100% and 100% patients in RA, FA and PA group (p=ns). Secondary access site was used in 30%, 3.3% and 30% in the RA, FA and PA access group (p&lt;0.01). Stent implantation was done in the femoral artery in 26.6%, 58.3% and 71.6% cases in RA, FA and PA group (p&lt;0.01). CTO recanalization was performed in 34/36 (100%), 30/30 (100%) and 45/45 (100%) cases successfully in RA, FA and PA group (p=ns). Contrast consumption, fluoroscopy and procedure time was not statistically different, but the X Ray dose was significantly lower in PA than in the RA and FA access group (63.1 vs 162 vs 153 Dyn). The cumulative rate of access site complications in the RA, FA and PA group was 3.3% (0% major and 3.3% minor), 15% (3.3% major and 11.6% minor) and 3.3% (0% major and 3.3% minor) (p&lt;0.01), respectively. The cumulative incidence of MAE's at 6 months in the RA, FA and PA group was 8.3% vs 13.3% and 18.3%. (p&lt;0.05) Conclusion Femoral artery intervention can be safely and effectively performed using radial, femoral and pedal access, but radial and pedal access is associated with less access site complication rate. Pedal access is associated with less X Ray dose than radial and femoral access. Funding Acknowledgement Type of funding source: None

scholarly journals Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 10 (10) ◽  
pp. 2163
Author(s):  
Gani Bajraktari ◽  
Zarife Rexhaj ◽  
Shpend Elezi ◽  
Fjolla Zhubi-Bakija ◽  
Artan Bajraktari ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Clinical Outcome ◽  
Major Bleeding ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access

Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. Conclusions: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.

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