Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta-analysis

Guillaume Marquis-Gravel, Maxime Tremblay-Gravel, Jonathan Lévesque, Philippe Généreux, Erick Schampaert, Donald Palisaitis, Michel Doucet, Thierry Charron, Paul Terriault, Pierre Tessier

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: The objective was to assess the effect of ultrasound (US)-guidance compared to the anatomical landmark (AL) approach in patients requiring femoral artery (FA) access for coronary angiography/percutaneous coronary interventions (PCI). Background: US-guidance has been proposed as a strategy to optimize FA access, potentially leading to decreased vascular complications. Methods: Patients requiring FA access for coronary angiography/PCI were randomized to the US-guided or AL approaches. The primary endpoint was a composite of immediate procedural vascular outcomes, and access-site outcomes at day one. Results were subsequently pooled in a study-level meta-analysis of randomized trials comparing US-guided FA access to another strategy. Results: A total of 129 patients were randomized (64 US-guided group; 65 AL group). The primary endpoint occurred in 30 patients (47%) with US, and in 39 patients (62%) with AL (P = 0.09). Four additional studies met the inclusion criteria and were included in the meta-analysis (1553 patients). Following data pooling, bleeding events (OR = 0.41; 95%CI 0.20-0.83; P = 0.01), venipunctures (OR = 0.18; 95%CI: 0.11-0.29; P < 0.0001), and multiple puncture attempts (OR = 0.24; 95%CI: 0.19-0.31; P < 0.0001) were significantly improved with US-guidance, but not successful common FA cannulation (OR = 0.84; 95%CI: 0.60-1.17; P = 0.29). Conclusion: Our study did not show significant benefits for the use of US to guide arterial femoral access compared to the anatomical landmark approach, but pooled analysis of five randomized trials showed decreased rates of bleeding events and venipunctures, and improved first-pass success. The clinical impact of these findings is uncertain, and do not warrant a systematic use of US-guidance in this clinical setting.

Original languageEnglish (US)
Pages (from-to)496-503
Number of pages8
JournalJournal of Interventional Cardiology
Volume31
Issue number4
DOIs
StatePublished - Aug 2018

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Femoral Artery
Coronary Angiography
Meta-Analysis
Randomized Controlled Trials
Phlebotomy
Percutaneous Coronary Intervention
Blood Vessels
Hemorrhage
Thigh
Punctures
Catheterization

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Marquis-Gravel, Guillaume ; Tremblay-Gravel, Maxime ; Lévesque, Jonathan ; Généreux, Philippe ; Schampaert, Erick ; Palisaitis, Donald ; Doucet, Michel ; Charron, Thierry ; Terriault, Paul ; Tessier, Pierre. / Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography : A randomized controlled trial and a meta-analysis. In: Journal of Interventional Cardiology. 2018 ; Vol. 31, No. 4. pp. 496-503.
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title = "Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta-analysis",
abstract = "Objectives: The objective was to assess the effect of ultrasound (US)-guidance compared to the anatomical landmark (AL) approach in patients requiring femoral artery (FA) access for coronary angiography/percutaneous coronary interventions (PCI). Background: US-guidance has been proposed as a strategy to optimize FA access, potentially leading to decreased vascular complications. Methods: Patients requiring FA access for coronary angiography/PCI were randomized to the US-guided or AL approaches. The primary endpoint was a composite of immediate procedural vascular outcomes, and access-site outcomes at day one. Results were subsequently pooled in a study-level meta-analysis of randomized trials comparing US-guided FA access to another strategy. Results: A total of 129 patients were randomized (64 US-guided group; 65 AL group). The primary endpoint occurred in 30 patients (47{\%}) with US, and in 39 patients (62{\%}) with AL (P = 0.09). Four additional studies met the inclusion criteria and were included in the meta-analysis (1553 patients). Following data pooling, bleeding events (OR = 0.41; 95{\%}CI 0.20-0.83; P = 0.01), venipunctures (OR = 0.18; 95{\%}CI: 0.11-0.29; P < 0.0001), and multiple puncture attempts (OR = 0.24; 95{\%}CI: 0.19-0.31; P < 0.0001) were significantly improved with US-guidance, but not successful common FA cannulation (OR = 0.84; 95{\%}CI: 0.60-1.17; P = 0.29). Conclusion: Our study did not show significant benefits for the use of US to guide arterial femoral access compared to the anatomical landmark approach, but pooled analysis of five randomized trials showed decreased rates of bleeding events and venipunctures, and improved first-pass success. The clinical impact of these findings is uncertain, and do not warrant a systematic use of US-guidance in this clinical setting.",
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Marquis-Gravel, G, Tremblay-Gravel, M, Lévesque, J, Généreux, P, Schampaert, E, Palisaitis, D, Doucet, M, Charron, T, Terriault, P & Tessier, P 2018, 'Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta-analysis', Journal of Interventional Cardiology, vol. 31, no. 4, pp. 496-503. https://doi.org/10.1111/joic.12492

Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography : A randomized controlled trial and a meta-analysis. / Marquis-Gravel, Guillaume; Tremblay-Gravel, Maxime; Lévesque, Jonathan; Généreux, Philippe; Schampaert, Erick; Palisaitis, Donald; Doucet, Michel; Charron, Thierry; Terriault, Paul; Tessier, Pierre.

In: Journal of Interventional Cardiology, Vol. 31, No. 4, 08.2018, p. 496-503.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography

T2 - A randomized controlled trial and a meta-analysis

AU - Marquis-Gravel, Guillaume

AU - Tremblay-Gravel, Maxime

AU - Lévesque, Jonathan

AU - Généreux, Philippe

AU - Schampaert, Erick

AU - Palisaitis, Donald

AU - Doucet, Michel

AU - Charron, Thierry

AU - Terriault, Paul

AU - Tessier, Pierre

PY - 2018/8

Y1 - 2018/8

N2 - Objectives: The objective was to assess the effect of ultrasound (US)-guidance compared to the anatomical landmark (AL) approach in patients requiring femoral artery (FA) access for coronary angiography/percutaneous coronary interventions (PCI). Background: US-guidance has been proposed as a strategy to optimize FA access, potentially leading to decreased vascular complications. Methods: Patients requiring FA access for coronary angiography/PCI were randomized to the US-guided or AL approaches. The primary endpoint was a composite of immediate procedural vascular outcomes, and access-site outcomes at day one. Results were subsequently pooled in a study-level meta-analysis of randomized trials comparing US-guided FA access to another strategy. Results: A total of 129 patients were randomized (64 US-guided group; 65 AL group). The primary endpoint occurred in 30 patients (47%) with US, and in 39 patients (62%) with AL (P = 0.09). Four additional studies met the inclusion criteria and were included in the meta-analysis (1553 patients). Following data pooling, bleeding events (OR = 0.41; 95%CI 0.20-0.83; P = 0.01), venipunctures (OR = 0.18; 95%CI: 0.11-0.29; P < 0.0001), and multiple puncture attempts (OR = 0.24; 95%CI: 0.19-0.31; P < 0.0001) were significantly improved with US-guidance, but not successful common FA cannulation (OR = 0.84; 95%CI: 0.60-1.17; P = 0.29). Conclusion: Our study did not show significant benefits for the use of US to guide arterial femoral access compared to the anatomical landmark approach, but pooled analysis of five randomized trials showed decreased rates of bleeding events and venipunctures, and improved first-pass success. The clinical impact of these findings is uncertain, and do not warrant a systematic use of US-guidance in this clinical setting.

AB - Objectives: The objective was to assess the effect of ultrasound (US)-guidance compared to the anatomical landmark (AL) approach in patients requiring femoral artery (FA) access for coronary angiography/percutaneous coronary interventions (PCI). Background: US-guidance has been proposed as a strategy to optimize FA access, potentially leading to decreased vascular complications. Methods: Patients requiring FA access for coronary angiography/PCI were randomized to the US-guided or AL approaches. The primary endpoint was a composite of immediate procedural vascular outcomes, and access-site outcomes at day one. Results were subsequently pooled in a study-level meta-analysis of randomized trials comparing US-guided FA access to another strategy. Results: A total of 129 patients were randomized (64 US-guided group; 65 AL group). The primary endpoint occurred in 30 patients (47%) with US, and in 39 patients (62%) with AL (P = 0.09). Four additional studies met the inclusion criteria and were included in the meta-analysis (1553 patients). Following data pooling, bleeding events (OR = 0.41; 95%CI 0.20-0.83; P = 0.01), venipunctures (OR = 0.18; 95%CI: 0.11-0.29; P < 0.0001), and multiple puncture attempts (OR = 0.24; 95%CI: 0.19-0.31; P < 0.0001) were significantly improved with US-guidance, but not successful common FA cannulation (OR = 0.84; 95%CI: 0.60-1.17; P = 0.29). Conclusion: Our study did not show significant benefits for the use of US to guide arterial femoral access compared to the anatomical landmark approach, but pooled analysis of five randomized trials showed decreased rates of bleeding events and venipunctures, and improved first-pass success. The clinical impact of these findings is uncertain, and do not warrant a systematic use of US-guidance in this clinical setting.

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