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<p>Ultrasound (US) guidance is increasingly used in invasive cardiac electrophysiology (EP) procedures for femoral vascular access. In this study, we assessed the occurrence of vascular access-related complications in EP procedures which were performed with the routine use of anatomical landmark (LM) versus US-guided vascular access. A total of 1119 consecutive EP procedures in 1012 patients performed in a two-year period from September 10, 2020 to September 10, 2022 were included. The endpoint of the present study consisted of any vascular access-related complication, classified as hematoma, aneurysm, or AV-fistula. Different risk factors for increased bleeding risk were analyzed. During the evaluation period, 777 procedures were performed using LM-guiding and 342 procedures using US-guided access. Overall, 19 (1.7%) relevant vascular complications occurred including: 15 (1.3%) hematoma, 2 (0.18%) aneurysm and 2 (0.18%) AV-fistula. 17 (2.2%) complications occurred in the LM-guided group and 2 (0.6%) in the US-guided group. A significant reduction of femoral complications by 89% was observed with introduction of routine US-guided access. 3.8% in the LM-group vs. 0.4% in the US-group (OR 0.1, 95% CI 0.0135–0.8515, <i>p</i> = 0.034). Intraprocedural ACT and the HASBLED score [range 0–4; mean = 1.47; maximum = 4) were shown to be independent predictors for vascular complications (OR 2.826, 95% CI 1.631–4.895, <i>p</i> &lt; 0.001). The use of US-guided vascular access significantly decreased the access-related complication rate in EP procedures. Higher procedural ACT and HASBLED score independently predicted a higher risk of vascular access complications.</p>

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Ultrasound-guided femoral venous access decreases vascular complications in catheter ablation procedures

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月3日

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  • Friederike Pavel,
  • S. C. R. Erlhöfer,
  • J. Wörmann,
  • S. Dittrich,
  • C. Scheurlen,
  • K. Filipovic,
  • J.-H. Schipper,
  • J.-H. van den Bruck,
  • A. Sultan,
  • J. Lüker,
  • D. Steven

摘要

Ultrasound (US) guidance is increasingly used in invasive cardiac electrophysiology (EP) procedures for femoral vascular access. In this study, we assessed the occurrence of vascular access-related complications in EP procedures which were performed with the routine use of anatomical landmark (LM) versus US-guided vascular access. A total of 1119 consecutive EP procedures in 1012 patients performed in a two-year period from September 10, 2020 to September 10, 2022 were included. The endpoint of the present study consisted of any vascular access-related complication, classified as hematoma, aneurysm, or AV-fistula. Different risk factors for increased bleeding risk were analyzed. During the evaluation period, 777 procedures were performed using LM-guiding and 342 procedures using US-guided access. Overall, 19 (1.7%) relevant vascular complications occurred including: 15 (1.3%) hematoma, 2 (0.18%) aneurysm and 2 (0.18%) AV-fistula. 17 (2.2%) complications occurred in the LM-guided group and 2 (0.6%) in the US-guided group. A significant reduction of femoral complications by 89% was observed with introduction of routine US-guided access. 3.8% in the LM-group vs. 0.4% in the US-group (OR 0.1, 95% CI 0.0135–0.8515, p = 0.034). Intraprocedural ACT and the HASBLED score [range 0–4; mean = 1.47; maximum = 4) were shown to be independent predictors for vascular complications (OR 2.826, 95% CI 1.631–4.895, p < 0.001). The use of US-guided vascular access significantly decreased the access-related complication rate in EP procedures. Higher procedural ACT and HASBLED score independently predicted a higher risk of vascular access complications.