COMPLICATIONS ASSOCIATED WITH FEMORAL ARTERY CANNULATION BY ANATOMICAL METHOD AND ULTRASOUND GUIDE TECHNIQUE
Main Article Content
Keywords
Artery Cannulation, Ultrasound-guided technique, Hematoma
Abstract
Background: Local vascular complications from femoral artery puncture include groin hematoma, retroperitoneal hematoma, vessel thrombosis, pseudoaneurysm, and arteriovenous fistula.
Objective: To compare the frequency of complications associated with femoral artery cannulation by anatomical method versus ultrasound-guided technique.
Material and Methods: Over the course of six months, from March 12, 2023, to September 11, 2023, this randomized controlled experiment was carried out at AFIC/NIHD, Rawalpindi. The research comprised 90 patients who had femoral artery coronary angiography coronary angiography, and they were divided into two groups at random. Group B got ultrasound-guided femoral artery cannulation, while Group A underwent anatomical technique of femoral artery cannulation. Following the operations, a resident cardiologist documented the findings and a consultant radiologist evaluated the net time consumed and the existence of retroperitoneal or localized hematoma.
Results: The research included ninety patients who were randomly assigned to a pair of groups, Group A (palpation technique) and Group B (ultrasound-guided method), for femoral artery coronary angiography coronary angiograms. Patients' ages ranged from 37.76 ± 9.49 years with an average to 25.6% female and 74.4% men. Comparing complications, Group A exhibited significantly higher rates of hematoma formation (33.33% vs. 8.89%, p=0.004), drop in blood pressure (33.33% vs. 13.33%, p=0.025), and blood transfusion (49% vs. 20%, p=0.04) compared to Group B. Additionally, age-stratified analysis revealed higher complication rates in Group A across both age categories (≤40 years and >40 years), with notable differences in hematoma formation, drop in blood pressure, and need for blood transfusions.
Conclusion: Compared to traditional artery catheterization, the ultrasound-guided technique increases first attempt success rates and reduces local-regional hematoma incidence in femoral artery catheterization.
References
2. Sorrentino S, Nguyen P, Salerno N, Polimeni A, Sabatino J, Makris A, Hennessy A, Giustino G, Spaccarotella C, Mongiardo A, De Rosa S. Standard versus ultrasound-guided cannulation of the femoral artery in patients undergoing invasive procedures: a meta-analysis of randomized controlled trials. Journal of Clinical Medicine. 2020 Mar 3;9(3):677.
3. Cho SA, Jang YE, Ji SH, Kim EH, Lee JH, Kim HS, Kim JT. Ultrasound-guided arterial catheterization. Anesthesia and pain medicine. 2021 Apr 4;16(2):119.
4. Nagashima F, Kon Y, Sugiyama T, Ishida K, Maruhashi T, Matsumura Y. A Guide to Femoral Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta. Journal of Endovascular Resuscitation and Trauma Management. 2022 May 20;6(1).
5. Oneissi M, Sweid A, Tjoumakaris S, Hasan D, Gooch MR, Rosenwasser RH, Jabbour P. Access-site complications in transfemoral neuroendovascular procedures: a systematic review of incidence rates and management strategies. Operative Neurosurgery. 2020 Oct 1;19(4):353-63.
6. Brenna CT, Ku JC, Pasarikovski CR, Priola SM, Dyer EE, Howard P, Kumar A, da Costa L, Yang VX. Access-site complications in ultrasound-guided endovascular thrombectomy: a single-institution retrospective cohort study. Neurosurgical Focus. 2021 Jul 1;51(1):E3.
7. Annetta MG, Marche B, Dolcetti L, Taraschi C, La Greca A, Musarò A, Emoli A, Scoppettuolo G, Pittiruti M. Ultrasound-guided cannulation of the superficial femoral vein for central venous access. The journal of vascular access. 2022 Jul;23(4):598-605.
8. Shaikh N, Chanda A, Ganaw A, Sameer M, Hassan J, Farooqi MW, Haji MM. Vascular Access: From Cannulation to Decannulation. InImproving Anesthesia Technical Staff’s Skills 2022 Feb 14 (pp. 171-195). Cham: Springer International Publishing.
9. Sorrentino S, Nguyen P, Salerno N, Polimeni A, Sabatino J, Makris A, Hennessy A, Giustino G, Spaccarotella C, Mongiardo A, De Rosa S. Standard versus ultrasound-guided cannulation of the femoral artery in patients undergoing invasive procedures: a meta-analysis of randomized controlled trials. Journal of Clinical Medicine. 2020 Mar 3;9(3):677.
10. 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 Jul 1;72(1):259-67.
11. Annetta MG, Marche B, Dolcetti L, Taraschi C, La Greca A, Musarò A, Emoli A, Scoppettuolo G, Pittiruti M. Ultrasound-guided cannulation of the superficial femoral vein for central venous access. The journal of vascular access. 2022 Jul;23(4):598-605.
12. Spencer TR, Pittiruti M. Rapid Central Vein Assessment (RaCeVA): a systematic, standardized approach for ultrasound assessment before central venous catheterization. The journal of vascular access. 2019 May;20(3):239-49.
13. Lamperti M, Biasucci DG, Disma N, Pittiruti M, Breschan C, Vailati D, Subert M, Traškaitė V, Macas A, Estebe JP, Fuzier R. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). European Journal of Anaesthesiology| EJA. 2020 May 1;37(5):344-76.
14. Kunhahamed MO, Abraham SV, Palatty BU, Krishnan SV, Rajeev PC, Gopinathan V. A comparison of internal jugular vein cannulation by ultrasound-guided and anatomical landmark technique in resource-limited emergency department setting. Journal of Medical Ultrasound. 2019 Oct 1;27(4):187-91.
15. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med.2003; 348:1123–1133
16. Oliver W, Nuttall G, Beynen F. The incidence of artery puncture with central venous cannulation using a modified technique for detection and prevention of arterial cannulation. J CardiothoacVascAnesth. 19987;11:851–5
17. Randolph A, Cook D, Gonzales C, Pribble C. Ultrasound guidance for placament of central venous catheters: a meta-analysis of the literature. Crit Care Med .1996;24:2053–58
18. Schummer W, Schummer C, Tuppatsch H, Fuchs J. Ultrasound-guided central venous cannulation: is there a difference between Doppler and B-mode ultrasound? J Clin Anesth.2006;18:167–72
19. Verghese S, McGill W, Patel R, Sell J, Midgley F, Ruttimann R. Comparison of three techniques for internal jugular vein cannulation in infants. PaedAnaesth .2000;10:505–11
20. Berenson GS Srinivasan SR BaoW Newman WP3rdTracyREWattigneyWA Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study N Engl J Med.1998;338:1650–6.
21. McGill HCJr McMahan CA Zieske AW Sloop GD Walcott JV Troxclair DA, et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. ArteriosclerThrombVasc Biol. 2000;20:1998–2004
22. McGill HCJr McMahan CA Zieske AW Tracy RE Malcom GT Herderick EE, et al. Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Circulation. 2000;102:374–9.
23. Gehrie E.R., Reynolds H.R., Chen A.Y. Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) Quality Improvement Initiative. Am. Heart J. 2009;158(4):688–94.
24. Merz C.N. The Yentl syndrome is alive and well. Eur. Heart J. 2011;32(11):1313–15.
25. Bugiardini R. Normal coronary arteries: clinical implications and further classification. Herz. 2005;30(1):3–7.
26. Ferrari R., Abergel H., Ford I. Gender- and age-related differences in clinical presentation and management of outpatients with stable coronary artery disease. Int. J. Cardiol. 2013;167(6):2938–43.
27. Shiloh A, Savel E, Paulin L. Ultrasound-guided catheterization of the radial artery: a systematic review and meta-analysis of randomized controller trials. Chest.2011; 139:524–29
28. M Tremblay-Gravel, G Marquis-Gravel, J Lévesque, D Palisaitis, P Généreux, M Doucet, P Tessier; comparison of anatomical versus ultrasound-guided techniques for femoral artery access in patients undergoing coronary angiography: a randomized single-blinded trial; Canadian J Cardiol. 2015;31(10):S25-6.
29. National Institute for Clinical Excellence. Guidance on the use of ultrasound locating devices for placing central venous catheters. National Institute for Clinical Excellence, London. www.nice.org.uk. Accessed 15 Dec 2011
30. Paul-Andre` C, Kendall J. Ultrasound guidance for vascular access. Emerg Med Clin N Am.2004;22:749–73
31. Blaivas M, Brannam L, Fernandez E. Short-axis versus long-axis approaches for teaching ultrasoundguided vascular access on a new inanimate model. AcadEmerg Med. 2003;10:1307–11
32. Caiozzo M, Quintini G, Cocchiera G,Greco G, Vaglica R, Pezzano G et al. Comparison of central venous catheterization with and without ultrasound guide. TransfusApher Sci. 2004;31(3):199-202.
33. Turker G, Kaya F, Gurbet A. Aksu H, Erdogan C, Atlas A. Internal jugular vein cannulation: an ultrasoundguided technique versus a landmark-guided technique. Clinics (Sao Paulo). 2009;64(10):989-92.
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Muhammad Yasin
Department Interventional Cardiology, AFIC/NIHD, Rawalpindi, Pakistan
Zaki Hamid
Emergency Department, Bahria International Hospital, Rawalpindi, Pakistan
Abeera Khalid
Department of Gynae & Obs, Fatima Memorial Hospital, Lahore, Pakistan
Sania Waqar
Radiology Department, Fatima Memorial Hospital, Lahore, Pakistan
Muhammad Talal
House Officer, Nishtar Hospital, Multan
Bilal Ashraf
House Officer, Department of Medicine, Saidu Group of Teaching Hospitals, Swat, Pakistan
Hosam Alazazzi
Royal College of Surgeons in Ireland - Bahrain
Kamel J. K. Walwil
Royal College of Surgeons in Ireland - Bahrain
Jumana Abdelrahman Diab
Royal College of Surgeons in Ireland - Bahrain