title: Ultrasound-Guided Arterial Access: Outcomes Among Patients With Peripheral Artery Disease and Critical Limb Ischemia Undergoing Peripheral Interventions.
abstract: OBJECTIVE
  Arterial cannulation is a vital component of endovascular interventions and often unconventional access approaches are required due to disease complexity. Historically, varying maneuvers have been utilized to obtain arterial access. Lack of consensus exists regarding the safest and most effective method. This study examined the feasibility and immediate outcomes of ultrasound-guided access in traditional and advanced access approaches.
  
  
  METHODS
  Data were analyzed from a cohort of 407 patients enrolled in the Peripheral RegIstry of Endovascular Clinical OutcoMEs (PRIME). The 407 patients underwent 649 procedures with 896 access sites utilized. Access success, immediate outcomes, complications, and length of hospital stay were analyzed.
  
  
  RESULTS
  Mean age was 70 years, and 67% were male. The majority of patients had critical limb ischemia (58%), 39% were Rutherford classification III. Most commonly utilized access sites were common femoral retrograde, common femoral antegrade, posterior tibial, and anterior tibial arteries (34.6%, 33.0%, 12.1%, and 12.1%, respectively). Mean number of attempts was 1.2, 1.2, 1.5, and 1.4, respectively; median time to access was 39, 45, 41, and 59 seconds, respectively; and access success rate was 99.4%, 97.3%, 90.7%, and 92.6%; respectively. Access-site combinations utilized were femoral antegrade (n = 188), femoral retrograde (n = 185), dual femoral/ tibio-pedal (n = 130), dual femoral retrograde (n = 44), retrograde tibio-pedal (n = 73), and other (n = 29). Access-related complications were low overall: hematoma (1.2%), bleeding requiring transfusion/intervention (1.7%), pseudoaneurysm (1.7%), arteriovenous fistula (0.3%), aneurysm (0%), compartment syndrome (0%), and death (0%).
  
  
  CONCLUSIONS
  Utilization of ultrasound-guided arterial access in this complex cohort was shown to be safe and effective regardless of arterial bed and approach.
authors.affiliation: Metro Health Hospital, 5900 Byron Center SW, PO Box 9490, Wyoming, MI 49519 USA. jihad.mustapha@metrogr.org.
authors.forename: J A
authors.initials: JA
authors.lastname: Mustapha
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Diaz-Sandoval
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.forename: George
authors.initials: G
authors.lastname: Adams
authors.forename: Robert
authors.initials: R
authors.lastname: Beasley
authors.forename: Sara
authors.initials: S
authors.lastname: Finton
authors.forename: Theresa
authors.initials: T
authors.lastname: McGoff
authors.forename: Larry E
authors.initials: LE
authors.lastname: Miller
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ansari
authors.forename: Fadi
authors.initials: F
authors.lastname: Saab
mesh_terms: D002406:Catheterization, Peripheral / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D007866:Leg / Q000098:blood supply; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012042:Registries; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*