Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial).
OBJECTIVE
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).
Seto
Arnold H
AH
Department of Medicine, Division of Cardiology, University of California, Irvine Medical Center, Orange, California 92868, USA. arnoldseto@yahoo.com
Abu-Fadel
Mazen S
MS
Sparling
Jeffrey M
JM
Zacharias
Soni J
SJ
Daly
Timothy S
TS
Harrison
Alexander T
AT
Suh
William M
WM
Vera
Jesus A
JA
Aston
Christopher E
CE
Winters
Rex J
RJ
Patel
Pranav M
PM
Hennebry
Thomas A
TA
Kern
Morton J
MJ
D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D011677:Punctures; D015641:Radiography, Interventional; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014481:United States