Ultrasound-guided femoral venous access decreases vascular complications in catheter ablation procedures

Ultrasound (US) guidance is increasingly used in invasive cardiac electrophysiology (EP) procedures for femoral vascular access. In this study, we assessed the occurrence of vascular access-related complications in EP procedures which were performed with the routine use of anatomical landmark (LM) versus US-guided vascular access. A total of 1119 consecutive EP procedures in 1012 patients performed in a two-year period from September 10, 2020 to September 10, 2022 were included. The endpoint of the present study consisted of any vascular access-related complication, classified as hematoma, aneurysm, or AV-fistula. Different risk factors for increased bleeding risk were analyzed. During the evaluation period, 777 procedures were performed using LM-guiding and 342 procedures using US-guided access. Overall, 19 (1.7%) relevant vascular complications occurred including: 15 (1.3%) hematoma, 2 (0.18%) aneurysm and 2 (0.18%) AV-fistula. 17 (2.2%) complications occurred in the LM-guided group and 2 (0.6%) in the US-guided group. A significant reduction of femoral complications by 89% was observed with introduction of routine US-guided access. 3.8% in the LM-group vs. 0.4% in the US-group (OR 0.1, 95% CI 0.0135-0.8515, p = 0.034). Intraprocedural ACT and the HASBLED score [range 0-4; mean = 1.47; maximum = 4) were shown to be independent predictors for vascular complications (OR 2.826, 95% CI 1.631-4.895, p < 0.001). The use of US-guided vascular access significantly decreased the access-related complication rate in EP procedures. Higher procedural ACT and HASBLED score independently predicted a higher risk of vascular access complications.