Does ultrasound guidance decrease femoral access site complications in neurointerventional procedures? A retrospective cohort study

Background: Ultrasound has been increasingly used to guide femoral arterial access for neuroendovascular procedures. Its effect on the safety outcomes has yet to be established.

Purpose: The purpose is to determine the effect of ultrasound-guided punctures on femoral access site complications (ASC), and to identify other potential predictors of ASC.

Materials and methods: We conducted a retrospective analysis of all the neurovascular cases performed with femoral arterial access between Jan 2016 and Dec 2022. Two groups of patients were selected: the first group had femoral arterial puncture without ultrasound guidance between Jan 2016 and Dec 2017 while the second group received femoral arterial puncture with ultrasound guidance between July 2019 and Dec 2022. Univariable and multivariable logistic regression analysis was conducted.

Results: A total of 2347 patients and 3181 procedures were included - 1376 in the non-ultrasound group and 1805 in the ultrasound group. The complication rate of femoral arterial access was 2 % (58/3181). There was no statistically significant difference in complication rate between the ultrasound and the non-ultrasound groups (p-value 0.821). Interventional procedures (in particular EVT), larger sheath size use (>/=7Fr) and DAPT were shown to be the independent predictors of femoral arterial ASC (p-value < 0.001), in both univariable and multivariable analyses. The use of larger sheath size and EVT procedures have lower odds of having complications in the ultrasound group compared to the non-ultrasound group (OR: 0.42 (0.09-1.83); p = 0.249 and OR: 0.64 (0.09-4.59); p = 0.663, respectively).

Conclusion: Our study found that the use of ultrasound does not have statistically significant impact on the safety outcome of femoral arterial access in neuro-endovascular procedures. It is, however, of benefit in high-risk cases. Independent predictors of femoral ASC include interventional vs diagnostic procedures, larger sheath size and DAPT intake. In these high-risk cases, ultrasound guidance helps to minimize femoral ASC.