title: Ultrasound-guided cannulation of the femoral vein in electrophysiological procedures: a systematic review and meta-analysis.
abstract: OBJECTIVE
  In an effort to minimize periprocedural stroke risk, increasingly, electrophysiological (EP) procedures are being performed on anticoagulation. The decrease in stroke has been accompanied by an increase in potentially devastating vascular access complications. Ultrasound guidance for femoral vein cannulation reduces complications in other applications. The aim of this study is to determine the utility of real-time two-dimensional (2D) ultrasound guidance for femoral vein cannulation in EP.
  
  
  RESULTS
  A comprehensive literature search of Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials was performed. Five years of conference abstracts from the Heart Rhythm Society, European Heart Rhythm Association, and European Cardiac Arrhythmia Society were reviewed. Two independent reviewers identified trials comparing ultrasound-guided with standard cannulation in EP procedures. Data were extracted on study design, study size, operator and patient characteristics, use of anticoagulation, vascular complication rates, first-pass success rate, and inadvertent arterial puncture. Four trials, with a total of 4065 subjects, were included in the review, with 1848 subjects in the ultrasound group and 2217 subjects in the palpation group. Ultrasound guidance for femoral vein cannulation was associated with a 60% reduction of major vascular bleeding (relative risk, 0.40; 95% confidence interval, 0.28-0.91). Additionally, there was a 66% reduction in minor vascular complications (relative risk, 0.34; 95% confidence interval, 0.15-0.78).
  
  
  CONCLUSIONS
  The use of real-time 2D ultrasound guidance for femoral vein cannulation decreases access-related bleeding rates and life-threatening vascular complications.
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Sobolev
authors.affiliation: Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Ariel L
authors.initials: AL
authors.lastname: Shiloh
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.|Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Slovut
mesh_terms: D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002404:Catheterization / Q000706:statistics & numerical data*; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D022062:Electrophysiologic Techniques, Cardiac / Q000706:statistics & numerical data*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging*; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*; D014652:Vascular Diseases / Q000453:epidemiology*
keywords: Complications; Electrophysiology; Ultrasound; Vascular