Ultrasound-Guided Venous Puncture Reduces Groin Complications in Electrophysiological Procedures

Abstract

Background: In electrophysiological procedures, multiple punctures on the femoral vein can be necessary depending on the number of catheters required. The femoral vein is typically located indirectly by using its anatomical relationship to the artery as a reference. However, this conventional approach can lead to significant complications, including bleeding, peri-interventional transfusion, pseudoaneurysms, or arteriovenous fistulas. Despite these risks, there is limited evidence comparing the safety of ultrasound-guided venipuncture versus the conventional technique in electrophysiological procedures. Objective: This study aimed to evaluate the impact of ultrasound-guided venipuncture on vascular access complications in electrophysiological procedures and to identify associated risk factors. Methods: In this single-center trial, patients scheduled for electrophysiological procedures at Ulm University Heart Center, Germany, were enrolled between November 2021 and October 2023. Venipuncture in the groin was performed using either the conventional or an ultrasound-guided approach. The primary composite endpoint was defined as peri-interventional major vascular access complications (Bleeding Academic Research Consortium (BARC) ≥2 bleeding, pseudoaneurysms, arteriovenous fistulas, and peri-interventional transfusion) and minor complications (BARC 1). Results: A total of 1370 patients were included: 749 in the conventional group and 621 in the ultrasound group. The primary endpoint was achieved in 19.2% of the conventional group and 12.1% of the ultrasound group (p < 0.001). An increased sheath diameter and a higher number of venous accesses were identified as risk factors for the primary endpoint. Conclusions: Ultrasound guidance for venous groin puncture in electrophysiological procedures reduces access-related complications, supporting its use with careful attention to sheath size and number.

Keywords: arteriovenous fistula; bleeding; cardiology; electrophysiology; pseudoaneurysm; ultrasound; vascular access complication; venipuncture.

Figure 1

Depiction of ultrasound guidance during venipuncture in the groin during electrophysiological procedures. The illustration shows the puncture of the venous vessels in the groin during an electrophysiological procedure under ultrasound guidance.

Figure 2

Example of a two-dimensional ultrasound transversal view of the groin vessels with and without color Doppler. Ultrasound images demonstrating a transversal view of the right groin, showing the femoral vessels. The femoral artery and vein are visualized in a transverse plane without (A) and with color Doppler ((B), artery: dark red color, vein: blue color), providing clear differentiation between the vascular structures. CFA, common femoral artery; CFV, common femoral vein.

Figure 3

Overview of complications after venipuncture in the groin in both study groups in direct comparison.

Figure 4

Overview of the major vascular access complications after venipuncture. BARC, Bleeding Academic Research Consortium.