Written by Chris Thom
Spoon Feed
In this single-center study of femoral venous access for electrophysiology procedures, the usage of ultrasound for venous access was associated with fewer complications.
Ultrasound reduces complications in femoral vein access
This single center retrospective study evaluated patients who received electrophysiology (EP) procedures over a 2 year period from 2020 to 2022. Halfway through that 2 year period, an exclusive US-guided access regimen was implemented, meaning that procedures after that time used US-guidance for access. There were a total of 1,119 EP procedures included. Outcomes assessed were vascular-access associated complications, to include hematoma, aneurysm, or AV fistula.
There were 777 procedures performed using landmark guidance for access and 342 with ultrasound guidance. The complication rate in the landmark group was 2.2%, as compared to 0.6% in the US-access group (p=0.040). The 2 complications in the US-access group were minor and represented simple hematomas. In contrast, the landmark guidance complications included AV-fistula and pseudo-aneurysm formation.
How will this change my practice?
The landmark subclavian vein and femoral vein cannulation linger on in practice despite mounting evidence to the contrary. It is indeed a sensical notion that actively watching the needle advance into the femoral vein will allow one to more effectively avoid an arterial puncture. And that is what we tend to see when the question is studied in the literature. The key caveat is the operator proficiency in “ultrasound guided needling.” If you push yourself to perform lots of ultrasound guided procedures and gain that skillset, you’ll find yourself readily able to sink these US guided femoral lines more quickly and efficiently than even the most seasoned landmark enthusiasts.
POCUS pro-tips and clips
Start at the inguinal groin crease and slide the probe medial and lateral to identify the great vessels. Often, the vessels are more medial than we initially suspect. Track the femoral vein distal and proximal a few centimeters to assess for site most amenable to puncture. The femoral artery will often wrap on top of the femoral vein as you move distal, so keep an eye out for that, and plan your approach more proximal. The stepwise process of finding your needle tip in the short axis works for this approach, but the steep angle sometimes required means you have to watch carefully to avoid the needle ending up deeper than anticipated.
Source
Ultrasound-guided femoral venous access decreases vascular complications in catheter ablation procedures. Sci Rep. 2025 Oct 3;15(1):34477. doi: 10.1038/s41598-025-21481-w. PMID: 41044329; PMCID: PMC12494763.
