Impact of combined imaging on complications associated with common femoral artery catheterization in treatment of peripheral artery diseases

• Maksim V. Agarkov
• Kirill L. Kozlov
• Evgenii Yu. Bessonov
• Olga B. Gertsog
• Dmitrii N. Lazakovich

Abstract

Catheterization of the common femoral artery (CFA) in the peripheral artery diseases treatment is associated with the risk of significant vascular complications and bleeding. The time puncture also affect the duration of the intervention. In this analysis, the combined imaging technology (FUSION technology) effect for puncture on puncture time, periprocedural and vascular complications was evaluated.

Material and methods. A retrospective patients subanalysis included in the database of the study of the effect of combined imaging on operational parameters in endovascular treatment of PAD was carried out. The femoral artery puncture method using a three-dimensional CT-based roadmap was introduced in 2020. Prior to the introduction of this technique, vascular puncture was performed on the basis of combining the X-ray data of bone landmarks and a certain palpation area of maximum pulsation, or according to the detected pulsation without fluoroscopy. Patients who underwent CFA puncture using the combined imaging technique (1^th group, n=158) were compared with patients who underwent CFA puncture using classical technique (control group, n=168). A standardized strategy of periprocedural anticoagulant therapy was adopted in both groups.

Results. The average age in the study group was 67.9 years compared with 68.10 years in the control group (p=0.87). Serious vascular complications and bleeding requiring blood transfusion in the combined imaging group compared with the control group had no significant differences. The use of combined imaging significantly reduced the likelihood of developing minor vascular complications (OR=2.47; 95% CI 1.18–7.26; p=0.046), transition to multiple access (OR=2.77; 95% CI 1.64–4.75; p<0.001), non-targeted insertion of an introducer in deep femoral artery with antegrade punctures (OR=8.4; 95% CI 1.09–385.02; p=0.033) time and number of attempts to puncture the target artery (OR=0.56; 95% CI 0.51–0.63; p<0.001).

Conclusion. The method of puncture of the common femoral artery using combined imaging was associated with a decrease in the operation time, the number of attempts at puncture of the artery, and a decrease in the chances of non-targeted insertion of the introducer into the deep femoral artery during antegrade puncture. This technique reduces the risk of major vascular complications and bleeding in the treatment of PAD and provides a simple and effective strategy for potentially improving patient outcomes.

Keywords:combined imaging; fusion technology; complications of the arterial puncture; peripheral artery disease

References

1. Sobolev M., Slovut D.P., Lee Chang A., Shiloh A.L., Eisen L.A. Ultrasound-Guided Catheterization of the Femoral Artery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of invasive cardiology. 2015; 27 (7): 318–23.

2. Roh J.W., Kim Y., Lee O.H., Im E., Cho D.K., Choi D., Jeong M.H. The learning curve of the distal radial access for coronary intervention. Scientific reports. 2021; 11 (1): 13217. DOI: https://doi.org/10.1038/s41598-021-92742-7

3. Zhao W., Peng H., Li H., Yi Y., Ma Y. He Y., Zhang H., Li T. Effects of ultrasound-guided techniques for radial arterial catheterization: A meta-analysis of randomized controlled trials. The American journal of emergency medicine. 2021; 46: 1–9. DOI: https://doi.org/10.1016/j.ajem.2020.04.064

4. Brass P., Hellmich M., Kolodziej L., Schick G., Smith, A.F. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. The Cochrane database of systematic reviews. 2015; 1(1): CD 006962. DOI: https://doi.org/10.1002/14651858.CD 006962.pub2

5. Sobolev M., Shiloh A.L., Di Biase L., Slovut D.P. Ultrasound-guided cannulation of the femoral vein in electrophysiological procedures: a systematic review and meta-analysis. Europace. 2017; 19 (5): 850–5. DOI: https://doi.org/10.1093/europace/euw113

6. Corvino A., Catalano O., de Magistris G., Corvino F., Giurazza F., Raffaella N., Vallone G. Usefulness of doppler techniques in the diagnosis of peripheral iatrogenic pseudoaneurysms secondary to minimally invasive interventional and surgical procedures: imaging findings and diagnostic performance study. Journal of ultrasound. 2020; 23 (4): 563–73. DOI: https://doi.org/10.1007/s40477-020-00475-6

7. Raft J., Coinus L., Lamotte A.S., Slosse C., Clerc-Urmès I., Baumann C., Richebé P., Bouaziz H. Arterial Cannulation Simulation Training in Novice Ultrasound Users. Respiratory care. 2022; 6 (9): 1154–60. DOI: https://doi.org/10.4187/respcare.09675

8. Hou Q., Zhou B., He J., Chen X., Zuo Y. Complications and related risk factors of transradial access cannulation for hemodynamic monitoring in general surgery: a prospective observational study. BMC anesthesiology. 2023; 2 (1): 228. DOI: https://doi.org/10.1186/s12871-023-02168-z

9. Kim H., Nam Y.S., Kim Y.S. The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve. Anatomy & cell biology. 2021; 54 (1): 124–7. DOI: https://doi.org/10.5115/acb.20.237

10. Castle E.V., Rathod K.S., Guttmann O.P., Jenkins A.M., McCarthy C.D., Knight C.J., O’Mahony C., Mathur A., Smith E.J., Weerackody R., Timmis A.D., Wragg A., Jones D.A. Routine use of fluoroscopic guidance and up-front femoral angiography results in reduced femoral complications in patients undergoing coronary angiographic procedures: an observational study using an Interrupted Time-Series analysis. Heart and vessels. 2019; 34 (3): 419–26. DOI: https://doi.org/10.1007/s00380-018-1266-6

11. Yiannakopoulos C., Sachinis N., Oluku J., Dellis S. Intra-articular Hip Injection Using Anatomical and Radiological Landmarks Without the Use of Ultrasound or Radiological Guidance. Cureus. 2022; 14 (3): e23581. DOI: https://doi.org/10.7759/cureus.23581

12. El-Mawardy M., Schwarz B., Landt M., Sulimov D., Kebernik J., Allali A., Becker B., Toelg R., Richardt G., Abdel-Wahab M. Impact of femoral artery puncture using digital subtraction angiography and road mapping on vascular and bleeding complications after transfemoral transcatheter aortic valve implantation. Euro Intervention. 2017; 12 (13): 1667–73. DOI: https://doi.org/10.4244/EIJ-D-15-00412

13. Pour-Ghaz I., Raja J., Bayoumi M., Manolukas T., Khouzam R.N., Ibebuogu U.N. Transcatheter aortic valve replacement with a focus on transcarotid: a review of the current literature. Annals of translational medicine. 2019; 7 (17): 420. DOI: https://doi.org/10.21037/atm.2019.07.11

14. Agarkov M.V., Kozlov K.L., Duke O.B. Combined visualization in endovascular treatment of pathology of the arteries of the lower extremities. Angiology and vascular surgery. 2023; 29 (1): 89–108. DOI: https://doi.org/10.33029/1027-6661-2023-29-1-89-98

15. Chun E.J. Ultrasonographic evaluation of complications related to transfemoral arterial procedures. Ultrasonography. 2018; 37 (2): 164–73. DOI: https://doi.org/10.14366/usg.17047

16. Vetrovec G.W., Kaki A., Wollmuth J., Dahle T.G. Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-supported High-risk Percutaneous Coronary Intervention. Heart international. 2022; 16 (2): 105–11. DOI: https://doi.org/10.17925/HI.2022.16.2.105

17. Rana N., Vijayvergiya R., Kasinadhuni G., Khanal S., Panda P. Comparison of radial versus femoral access using hemostatic devices following percutaneous coronary intervention. Indian heart journal. 2021; 73 (3): 382–4. DOI: https://doi.org/10.1016/j.ihj.2021.04.006

18. van Wiechen M.P., Ligthart J.M., Van Mieghem N.M. Large-bore Vascular Closure: New Devices and Techniques. Interventional cardiology. 2019; 14 (1): 17–21. DOI: https://doi.org/10.15420/icr.2018.36.1

19. Stone P., Campbell J., Thompson S., Walker J. A prospective, randomized study comparing ultrasound versus fluoroscopic guided femoral arterial access in noncardiac vascular patients. Journal of vascular surgery. 2020; 72 (1): 259–67. DO: https://doi.org/10.1016/j.jvs.2019.09.051

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)