Peripheral Vascular Disease Clinical Trial
Official title:
Femoral Arterial Access With Ultrasound Trial
This study is designed to evaluate the routine use of vascular ultrasound as an aid for proper placement of a femoral arterial sheath during cardiac catheterization and peripheral arterial angiography.
Cardiac catheterization is conventionally performed with femoral arterial access using a
combination of arterial pulse palpation, anatomical landmarks, and fluoroscopic landmarks to
guide needle insertion. Vascular access complications including hematoma formation,
retroperitoneal bleeding, and arterial dissection are the most common types of adverse
events associated with cardiac catheterization, and have been associated with insertions
above and below the level of the common femoral artery. Real-time ultrasound assistance for
central venous catheter placement has been proven in multiple studies to reduce
complications, and has been recommended by the Agency for Healthcare Research and Quality as
a "Top 11 Highly Proven" patient safety practice. This recommendation has not yet been
extended to arterial access, due to a lack of studies to date. However, ultrasound
assistance is licensed for and commonly utilized for arterial access, especially in
difficult patients.
In a pilot study of 71 procedures performed by the lead researcher, ultrasound guidance was
associated with an improved 1st pass success rate (83% vs 47%, p=0.002), reduced risk of
accidental venipunctures (0% vs 25%, p=0.002), and greater overall success in common femoral
artery cannulation (89% vs 69%, p=0.048) as compared with the fluoroscopic control.
This study is a multicenter prospective randomized trial to generalize the above findings
with more patients studied, a larger number of operators, and across several centers.
Similar to the previous study, the ultrasound will be used real-time to visualize the
femoral vein, femoral artery, and needle tract as the needle is inserted, to guide the
needle towards the appropriate location in the artery. The time for insertion, number of
passes, complications, and position of the insertion catheter on the femoral angiogram will
be analyzed in the setting of patient factors including age, body mass index, and presence
of peripheral vascular disease.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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