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Review
. 2023 Jun 11;13(12):2028.
doi: 10.3390/diagnostics13122028.

Ultrasound-Guided Femoral Vascular Access for Percutaneous Coronary and Structural Interventions

Iosif Xenogiannis  1   2 , Charalampos Varlamos  1 , Thomas R Keeble  3 , Andreas S Kalogeropoulos  2 , Grigoris V Karamasis  1   3
Affiliations
Review

Ultrasound-Guided Femoral Vascular Access for Percutaneous Coronary and Structural Interventions

Iosif Xenogiannis et al. Diagnostics (Basel). .

Abstract

Radial access has largely substituted femoral access for coronary interventions. Nevertheless, the femoral artery remains indispensable for gaining access to structural and complex percutaneous coronary interventions such as transcatheter aortic valve implantation and chronic total occlusion interventions, respectively. Ultrasound-guided femoral puncture is a broadly available, inexpensive, and relatively easy-to-learn technique. According to the existing evidence, ultrasound guidance for gaining femoral access has improved the effectiveness and safety of the technique. In the present paper, we sought to review the current literature in order to provide the reader with up-to-date data regarding the benefits of ultrasound-guided femoral access compared with the conventional technique as well as describing the state-of-the-art technique for gaining femoral access under ultrasound guidance.

Keywords: coronary angiography; femoral artery; percutaneous coronary interventions (PCI); transaortic valve implantation (TAVI); ultrasound-guided access.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Sheath insertion in the “optimal puncture zone”.
Figure 2
Figure 2
(A) Fluoroscopy is used in order to identify the femoral head, and then, the lower edge of the femoral head is marked with a hemostat. (B) Ultrasound is used in order to identify the femoral artery. When both superficial and profunda femoral arteries are visible, the probe has been placed under bifurcation (left panel), while when only the common femoral artery is visible, the probe is above femoral bifurcation (right panel), indicating the appropriate puncture site. Common, profunda and superficial femoral arteries are indicated with red color while the femoral vein is indicated with blue color. Reprinted from JACC Cardiovasc Interv. Volume 10, issue 22. Sandoval Y, Burke MN, Lobo AS, et al. Contemporary arterial access in the cardiac catheterization laboratory. Pages 2233–2241, 2017 [31]. Used with permission from Elsevier.
Figure 3
Figure 3
Angiographic and matched ultrasound images of femoral artery wall calcification and superficial femoral artery occlusion in a patient who had Transcatheter Aortic Valve Implantation. (A) Fluoroscopy at the level of the right hip shows a significantly calcified right femoral artery wall (arrows). (B) Ultrasound confirms the previous finding illustrating circumferential calcification of the profunda (yellow arrows) and calcified plaques in the superficial femoral artery (blue arrows). (C) Superficial femoral artery occlusion after the placement of two Perclose Proglide (Abbott Vascular, Redwood City, CA, USA) closure devices. (D) Ultrasound illustrates the presence of superficial femoral artery occlusion.
Figure 4
Figure 4
(A) Femoral angiography of a patient who will undergo coronary angiography. (B) Right femoral imaging with ultrasound in the same patient after coronary angiography completion (longitudinal axis). An Angio-Seal vascular closure device was placed in the right femoral artery (arrow).
See this image and copyright information in PMC

References

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