A Comparison Between Two Different Directions of Landmark-Guided Femoral Vein Puncture: A Prospective Randomized...

Area of Science:

• Vascular Access Techniques
• Interventional Cardiology
• Anatomy and Physiology

Background:

• Anatomical variations between the femoral vein and artery increase the risk of vascular injury during percutaneous procedures.
• Clinical evidence comparing different femoral vein puncture directions is limited.
• Understanding optimal puncture techniques is crucial for patient safety.

Purpose of the Study:

• To prospectively compare the efficacy and safety of lateral versus orthogonal femoral vein puncture approaches.
• To evaluate the impact of puncture direction on success rates, procedure time, and complications.
• To identify specific anatomical scenarios where one approach may be superior.

Main Methods:

• A prospective randomized controlled trial was conducted with 108 patients undergoing percutaneous femoral venous catheterization.
• Patients were randomized into two groups: lateral puncture approach and orthogonal puncture approach.
• Primary outcome was first-attempt success rate; secondary outcomes included overall success, attempts, time, and complications.

Main Results:

• The lateral approach group showed a significantly higher first-attempt success rate (76% vs. 52%) and overall success rate (91% vs. 61%).
• Fewer puncture attempts (p=0.004) and shorter puncture times (median difference: -6.0s) were observed with the lateral approach.
• The benefits of the lateral approach were more pronounced when femoral artery and vein lumen overlap occurred; complication rates were similar between groups.

Conclusions:

• The lateral approach for femoral vein puncture, using anatomical landmarks, enhances success rates and reduces operating time.
• This technique is particularly advantageous in cases with partial or complete femoral artery and vein overlap.
• The lateral approach does not increase the risk of local complications, making it a safer and more efficient option.