Sorrentino Sabato, Nguyen Phong, Salerno Nadia, Polimeni Alberto, Sabatino Jolanda, Makris Angela, Hennessy Annemarie, Giustino Gennaro, Spaccarotella Carmen, Mongiardo Annalisa, De Rosa Salvatore, Juergens Craig, Indolfi Ciro
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy.
Campbelltown Hospital, Campbelltown, NSW 2560, Australia.
J Clin Med. 2020 Mar 3;9(3):677. doi: 10.3390/jcm9030677.
It is unclear whether or not ultrasound-guided cannulation (UGC) of the femoral artery is superior to the standard approach (SA) in reducing vascular complications and improving access success.
We sought to compare procedural and clinical outcomes of femoral UGC versus SA in patients undergoing percutaneous cardiovascular intervention (PCvI).
We searched EMBASE, MEDLINE, Scopus and web sources for randomized trials comparing UGC versus SA. We estimated risk ratio (RR) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) for categorical and continuous variables, respectively. Primary efficacy endpoint was the success rate at the first attempt, while secondary efficacy endpoints were access time and number of attempts. Primary safety endpoints were the rates of vascular complications, while secondary endpoints were major bleeding, as well as access site hematoma, venepuncture, pseudoaneurysms and retroperitoneal hematoma. This meta-analysis has been registered on Centre for Open Science (OSF) (osf.io/fy82e).
Seven trials were included, randomizing 3180 patients to UGC ( = 1564) or SA ( = 1616). Efficacy between UGC and SA was the main metric assessed in most of the trials, in which one third of the enrolled patients underwent interventional procedures. The success rate of the first attempt was significantly higher with UGC compared to SA, (82.0% vs. 58.7%; RR: 1.36; 95% CI: 1.17 to 1.57; < 0.0001; I = 88%). Time to access and number of attempts were significantly reduced with UGC compared to SA (SMD: -0.19; 95% CI: -0.28 to -0.10; < 0.0001; I = 22%) and (SMD: -0.40; 95% CI: -0.58 to -0.21; p < 0.0001; I = 82%), respectively. Compared with SA, use of UGC was associated with a significant reduction in vascular complications (1.3% vs. 3.0%; RR: 0.48; CI 95%: 0.25 to 0.91; = 0.02; I = 0%) and access-site hematoma (1.2% vs. 3.3%; RR: 0.41; CI 95%: 0.20 to 0.83; = 0.01; I = 27%), but there were non-significant differences in major bleeding (0.7% vs. 1.4%; RR: 0.57; CI 95%: 0.24 to 1.32; = 0.19; I = 0%). Rates of venepuncture were lower with UGC (3.6% vs. 12.1%; RR: 0.32; CI 95%: 0.20 to 0.52; < 0.00001; I = 55%).
This study, which included all available data to date, demonstrated that, compared to a standard approach, ultrasound-guided cannulation of the femoral artery is associated with lower access-related complications and higher efficacy rates. These results could be of great clinical relevance especially in the femoral cannulation of high risk patients.
目前尚不清楚在减少血管并发症和提高穿刺成功率方面，超声引导下股动脉插管（UGC）是否优于标准方法（SA）。
我们旨在比较接受经皮心血管介入治疗（PCvI）的患者中，股动脉UGC与SA的操作过程和临床结局。
我们检索了EMBASE、MEDLINE、Scopus和网络资源，以查找比较UGC与SA的随机试验。我们分别对分类变量和连续变量估计了风险比（RR）和标准化均数差（SMD）及其95%置信区间（CI）。主要疗效终点是首次尝试的成功率，次要疗效终点是穿刺时间和尝试次数。主要安全终点是血管并发症的发生率，次要终点是大出血，以及穿刺部位血肿、静脉穿刺、假性动脉瘤和腹膜后血肿。该荟萃分析已在开放科学中心（OSF）注册（osf.io/fy82e）。
纳入了7项试验，将3180例患者随机分为UGC组（n = 1564）或SA组（n = 1616）。大多数试验评估的主要指标是UGC和SA之间的疗效，其中三分之一的入选患者接受了介入手术。与SA相比，UGC首次尝试的成功率显著更高（82.0%对58.7%；RR：1.36；95%CI：1.17至1.57；P < 0.0001；I² = 88%）。与SA相比，UGC的穿刺时间和尝试次数显著减少（SMD：-0.19；95%CI：-0.28至-0.10；P < 0.0001；I² = 22%）和（SMD：-0.40；95%CI：-0.58至-0.21；P < 0.0001；I² = 82%）。与SA相比，使用UGC与血管并发症（1.3%对3.0%；RR：0.48；95%CI：0.25至0.91；P = 0.02；I² = 0%）和穿刺部位血肿（1.2%对3.3%；RR：0.41；95%CI：0.20至0.83；P = 0.01；I² = 27%）的显著减少相关，但大出血方面无显著差异（0.7%对1.4%；RR：0.57；95%CI：0.24至1.32；P = 0.19；I² = 0%）。UGC的静脉穿刺率较低（3.6%对12.1%；RR：0.32；95%CI：0.20至0.52；P < 0.00001；I² = 55%）。
这项纳入了迄今为止所有可用数据的研究表明，与标准方法相比，超声引导下股动脉插管相关的穿刺并发症更低，成功率更高。这些结果可能具有重要的临床意义，尤其是在高危患者的股动脉插管中。
