[Clinical value of Doppler ultrasound controlled puncture of the inguinal vessels with the "Smart Needle" within the scope of heart catheter examination].

Due to the increasing number of diagnostic heart catheterizations, especially in elderly patients, as well as the increase of percutaneous transluminal coronary angioplasties, we are confronted with a rise in peripheral complications evolving from difficulties in the procedure of the puncture of the femoral artery or vene. The development of greater hematomas in the area of the puncture, the formation of arterio-venous fistulas and aneurysma spuria are the foremost complications. It was the aim of the study to investigate in as far an improved puncture technique could reduce the rate of peripheral complications. In this comparative study the vessel punctures were carried out by the conventional Judkins puncture technique and a new method using a special puncture needle. (Smart Needle" R), with an integrated ultrasonic sound device. In this study 114 patients--age 23 to 82 years--undergoing heart catheterization (91 diagnostics, 23 PTCAs) were examined. In all cases a puncture of the arterial and venous femoral vessel was done. 50 patients received a puncture via "Smart Needle" and the remaining 64 patients were punctured conventionally. In contrast to the group of patients receiving conventional puncture of the femoral artery, where in 72% more than one try was needed, in all patients of the "Smart Needle" group the first puncture was successive. Concerning the puncture of the venous vessels no significant difference between the two groups was observed. This difference between arterial and venous puncture outcome results from the difference between arterial and venous flow signals detected by the ultrasonic sound device. As to the bleeding complications hematomas following to "Smart Needle" puncture occurred less frequently-in 25%--and were significantly smaller than in the conventional group where hematomas were seen in 46%. The number of patients with hematomas with diameters of more than 5 cm was twice as high in the conventionaly punctured group (28%) than in the "Smart Needle" group (14%). However, patients suffering from arterial hypertension or hemostatic disorders showed an increased risk of vascular complications. In regard to the cost-benefit relation an indication for the use of the new technique is to be seen especially in overweight patients and patients suffering to aortic stenosis or cardiogenic shock.