Ultrasound Guidance for Vascular Access for Coronary Angiogram: A Meta-Analysis of Randomized Controlled Trials

Authors

Tzvi Fishkin, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
Ameesh Isath, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
Hafeez Ul Virk, Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Dhrubajyoti Bandyopadhyay, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
Zhen Wang, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Srihari S. Naidu, Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York.
Hani Jneid, Division of Cardiology, University of Texas Medical Branch, Houston, Texas.
Chayakrit Krittanawong, Cardiology Division, New York University Langone Health and New York University School of Medicine, New York, New York. Electronic address: Chayakrit.Krittanawong@nyulangone.org.

Author Type(s)

Resident/Fellow, Faculty

DOI

10.1016/j.amjcard.2023.08.014

Journal Title

The American Journal of Cardiology

First Page

70

Last Page

72

Document Type

Article

Publication Date

11-1-2023

Department

Medicine

Abstract

Obtaining vascular access during percutaneous coronary intervention is necessary to facilitate the procedure but carries procedural risks that impact patient outcomes. Historically, vascular access has been accomplished using anatomic landmarks, pulsation, and/or fluoroscopic guidance. Ultrasound (US) guidance has emerged as a modality for achieving vascular access in a multitude of interventional procedures including those in the cardiac catheterization laboratory. US use has been demonstrated in randomized controlled trials and meta-analyses to be associated with an increased success rate for vascular access with fewer complications, although the data are mixed. We aimed to re-evaluate the totality of evidence in an updated meta-analysis to compare the ease of access and complications rates between US-guided and manual vascular access. A meta-analysis of 8 randomized controlled trials including 5,170 patients was performed. The primary outcome evaluated was the rate of access failure, and the secondary outcomes included hematomas and access site bleeding. US-guided arterial access was associated with a significantly higher rate of first-attempt success and a decreased risk of venipuncture. US use had a trend toward a lower total number of attempts, but the results were not significant. This updated meta-analysis further supports the use of US for vascular access for coronary angiography because of higher rates of first-attempt success and reduced venipuncture. However, there was no significant difference in vascular complications such as hematoma, pseudoaneurysm, and bleeding complications. Because of the high morbidity of bleeding complications associated with coronary angiography, further research should be done to reduce these complications.

Recommended Citation

Fishkin, T., Isath, A., Virk, H. U., Bandyopadhyay, D., Wang, Z., Naidu, S. S., Jneid, H., & Krittanawong, C. (2023). Ultrasound Guidance for Vascular Access for Coronary Angiogram: A Meta-Analysis of Randomized Controlled Trials. The American Journal of Cardiology, 206, 70-72. https://doi.org/10.1016/j.amjcard.2023.08.014