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Real-Time Ultrasound Guidance Facilitates Femoral Arterial Access and Reduces Vascular Complications

FAUST (Femoral Arterial Access With Ultrasound Trial)

Arnold H. Seto, MD, MPA^_*,_*, Mazen S. Abu-Fadel, MD, Jeffrey M. Sparling, MD, Soni J. Zacharias, MD, Timothy S. Daly, MD, Alexander T. Harrison, MD^_*, William M. Suh, MD^_*, Jesus A. Vera, MD^_*, Christopher E. Aston, PhD, Rex J. Winters, MD, Pranav M. Patel, MD^_*, Thomas A. Hennebry, MB, BCh, BAO, Morton J. Kern, MD^_*

^_* Department of Medicine, Division of Cardiology, University of California, Irvine Medical Center, Orange, California
Department of Internal Medicine, Section of Cardiovascular Diseases, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
University of Oklahoma Health Sciences Center, General Clinical Research Center, Oklahoma City, Oklahoma
Memorial Heart Institute, Long Beach Memorial Medical Center, Long Beach, California

^_* Reprint requests and correspondence: Dr. Arnold H. Seto, Division of Cardiology, UC-Irvine Medical Center, 200 South Manchester Avenue, Suite 400, Orange, California 92868 (Email: arnoldseto{at}yahoo.com).

Objectives: The aim of this study was to compare the procedural and clinical outcomes of femoral arterial access with ultrasound (US) guidance with standard fluoroscopic guidance.

Background: Real-time US guidance reduces time to access, number of attempts, and complications in central venous access but has not been adequately assessed in femoral artery cannulation.

Methods: Patients (n = 1,004) undergoing retrograde femoral arterial access were randomized 1:1 to either fluoroscopic or US guidance. The primary end point was successful common femoral artery (CFA) cannulation by femoral angiography. Secondary end points included time to sheath insertion, number of forward needle advancements, first pass success, accidental venipunctures, and vascular access complications at 30 days.

Results: Compared with fluoroscopic guidance, US guidance produced no difference in CFA cannulation rates (86.4% vs. 83.3%, p = 0.17), except in the subgroup of patients with CFA bifurcations occurring over the femoral head (82.6% vs. 69.8%, p < 0.01). US guidance resulted in an improved first-pass success rate (83% vs. 46%, p < 0.0001), reduced number of attempts (1.3 vs. 3.0, p < 0.0001), reduced risk of venipuncture (2.4% vs. 15.8%, p < 0.0001), and reduced median time to access (136 s vs. 148 s, p = 0.003). Vascular complications occurred in 7 of 503 and 17 of 501 in the US and fluoroscopy groups, respectively (1.4% vs. 3.4% p = 0.04).

Conclusions: In this multicenter randomized controlled trial, routine real-time US guidance improved CFA cannulation only in patients with high CFA bifurcations but reduced the number of attempts, time to access, risk of venipunctures, and vascular complications in femoral arterial access. (Femoral Arterial Access With Ultrasound Trial [FAUST]; NCT00667381)

Key Words: complications • ultrasound • vascular access

Abbreviations and Acronyms   CFA = common femoral artery   US = ultrasound

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