title: Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial).
abstract: 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).
authors.affiliation: Department of Medicine, Division of Cardiology, University of California, Irvine Medical Center, Orange, California 92868, USA. arnoldseto@yahoo.com
authors.forename: Arnold H
authors.initials: AH
authors.lastname: Seto
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Abu-Fadel
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sparling
authors.forename: Soni J
authors.initials: SJ
authors.lastname: Zacharias
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Daly
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Harrison
authors.forename: William M
authors.initials: WM
authors.lastname: Suh
authors.forename: Jesus A
authors.initials: JA
authors.lastname: Vera
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Aston
authors.forename: Rex J
authors.initials: RJ
authors.lastname: Winters
authors.forename: Pranav M
authors.initials: PM
authors.lastname: Patel
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Hennebry
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Kern
mesh_terms: 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