title: Routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases groin hematoma rates.
abstract: BACKGROUND
  Use of fluoroscopy and bone landmarks to guide percutaneous common femoral artery (CFA) access has decreased access site complications compared with palpation alone. However, only limited case series have examined the benefits of ultrasound to guide CFA access during peripheral vascular intervention (PVI). We evaluated the effect of routine vs selective use of ultrasound guidance (UG) on groin hematoma rates after PVI.
  
  
  METHODS
  The Vascular Study Group of New England database (2010-2014) was queried to identify the complication of postprocedural groin hematoma after 7359 PVIs performed through CFA access. Hematoma (including pseudoaneurysms) was defined as minor (requiring compression or observation), moderate (requiring transfusion or thrombin injection), and major (requiring operation). Both procedure-level and interventionalist-level analyses were performed. Multivariable Poisson regression models were used to compare hematoma rates of interventionalists based on routine (≥80% of PVIs) and selective (<80%) utilization of UG in the adjusted overall sample and in multiple subgroups.
  
  
  RESULTS
  The overall postprocedural groin hematoma rate after PVI was 4.5%, and the rate of combined moderate and major hematoma was 0.8%. Among 114 interventionalists with ≥10 PVI procedures, routine and selective UG was used by 31 (27%) and 83 (73%) interventionalists, respectively. Routine UG was protective against hematoma (rate ratio [RR], 0.62; 95% confidence interval [CI], 0.46-0.84; P < .01). Subgroup analysis revealed that routine UG was also protective against hematoma under the following circumstances: age >80 years (RR, 0.47; 95% CI, 0.27-0.85; P = .01), body mass index ≥30 (RR, 0.51; 95% CI, 0.29-0.90; P = .02), and sheath size >6F (RR, 0.43; 95% CI, 0.23-0.79; P < .01).
  
  
  CONCLUSIONS
  Routine UG may potentially protect against the complication of hematoma for both modifiable and nonmodifiable patient and procedural characteristics. Encouraging routine UG is a feasible quality improvement opportunity to decrease patient morbidity after PVI.
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Mass. Electronic address: jeffrey.kalish@bmc.org.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kalish
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Mass.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Eslami
authors.affiliation: Department of Vascular Surgery, Southcoast Health System, Fall River, Mass.
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.affiliation: Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
authors.forename: Marc
authors.initials: M
authors.lastname: Schermerhorn
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Mass.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Mass.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Mass.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000293:injuries*; D006119:Groin / Q000098:blood supply*; D006406:Hematoma / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult