Can Ultrasound-Guided in-Plane Puncture Technique Enhance the Precision of Femoral Artery Access? The Randomized PARFEM Trial.

BACKGROUND

Ultrasound-guided puncture of the common femoral artery (CFA) is assumed to be more precise than conventional techniques without ultrasound. However, previous comparative studies have shown partly contradictory results with regard to success of ultrasound-guided puncture so that this method is not yet standard in transfemoral cardiac catheterization.

AIMS: The PARFEM trial was performed to investigate whether an ultrasound-assisted in-plane technique using a needle guide could improve the precision of CFA puncture.

METHODS

The study was conducted in 286 patients undergoing transfemoral cardiac catheterization. Patients were randomized 1:1, and femoral artery puncture was performed either using an ultrasound-guided in-plane technique with fluoroscopic marking of the center of the femoral head or a conventional approach. The primary endpoint was successful puncture of the CFA with the first attempt. In addition, the influence of the examiners' level of experience on puncture results was investigated.

RESULTS

Primary successful puncture of the CFA was achieved more frequently in the ultrasound group than in the control group: 79.6% versus 55.6%, odds ratio 3.25 [95% CI: 1.92-5.23], p < 0.001. This favorable effect of ultrasound guidance was independent of the examiners' level of experience. The success rate of ultrasound-guided sheath placement within the CFA was 97.2%, compared to 77.8% in the control group (p < 0.01).

CONCLUSIONS

The PARFEM trial demonstrated that in-plane ultrasound guidance can improve the precision of femoral puncture and reduce the occurrence of inadequate sheath placements. The results support the incorporation of this technique into standard practice for guiding transfemoral puncture.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06065943.