Randomized trial of an oblique versus standard fluoroscopic-guided micropuncture technique for femoral arterial access: The Micropuncture-CFA trial.

Autor: Leesar MA; Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America. Electronic address: mleesar@uab.edu., Waheed S; Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America; Division of Cardiology, University of Illinois, Chicago, IL, United States of America., Al Solaiman F; Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America., Chatterjee A; Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America; Division of Cardiology, Banner-University Medical Center in Tucson, AZ, United States of America., Daya HA; Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America., Hage FG; Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America., Brott BC; Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2023 Dec; Vol. 57, pp. 43-50. Date of Electronic Publication: 2023 Jun 28.
DOI: 10.1016/j.carrev.2023.06.029
Abstrakt: Background: The anterior-posterior fluoroscopic guidance (the AP technique) is a standard method for common femoral artery (CFA) access, but the rate of CFA access with ultrasound vs. the AP technique was not significantly different. We have shown an oblique fluoroscopic guidance (the oblique technique) with a micropuncture needle (MPN) resulted in CFA access in 100 % of patients. The outcome of the oblique vs. AP technique is unknown. We compared the utilities of the oblique vs. AP technique for CFA access with a MPN in patients undergoing coronary procedures.
Methods: A total of 200 patients were randomized to the oblique vs. AP technique. Using the oblique technique, a MPN was advanced to the mid pubis in the 20° ipsilateral right-or left anterior oblique view with fluoroscopic guidance and the CFA was punctured. In the AP technique, a MPN was advanced to the mid femoral head in the AP view with fluoroscopic guidance and the CFA was punctured. The primary endpoint was the rate of successful access to the CFA.
Results: The rates of first pass and CFA access were higher with the oblique vs. AP technique (82 % vs. 61 %, and 94 % vs. 81 %, respectively; P < 0.01). The number of needle punctures was lower with the oblique vs. AP technique (1.1 ± 0.39 vs. 1.4 ± 0.78, respectively; P < 0.01). In high CFA bifurcations, the rate of CFA access was higher with the oblique vs. AP technique (76 % vs. 52 %, respectively; P < 0.01). Vascular complications were lower with the oblique vs. AP technique (1 % vs. 7 %, respectively; P < 0.05).
Conclusions: Our data suggest that the oblique technique, compared with the AP technique, significantly increased the rates of first pass and access to the CFA, and decreased the number of punctures and vascular complication.
Trial Registration: ClinicalTrials.gov Identifier: NCT03955653.
Competing Interests: Declaration of competing interest Massoud Leesar received institutional grant from ACIST. All others have no conflict of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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