J Cerebrovasc Endovasc Neurosurg.  2017 Dec;19(4):276-283. 10.7461/jcen.2017.19.4.276.

Prepuncture Ultrasound Examination Facilitates Safe and Accurate Common Femoral Artery Access for Transfemoral Cerebral Angiography

• Son SY
• Cho KC
• Cho P
• Lee JH
• Myoung SU
• Choi JH

• KMID: 2401780
• DOI: http://doi.org/10.7461/jcen.2017.19.4.276

Abstract

OBJECTIVE
We aimed to introduce our method involving prepuncture ultrasound scan for cannulation of the common femoral artery (CFA) during transfemoral cerebral angiography (TFCA), and to assess the clinical and radiological outcomes. MATERIAL AND METHODS: Our study included 90 patients who underwent prepuncture ultrasound examination of the inguinal area for TFCA between April 2015 and June 2015. Prior to skin preparation and draping of the inguinal area, we identified the CFA and its bifurcation using ultrasound. Based on the ultrasound findings, we marked cruciate lines in the inguinal area. Thereafter, we inserted a puncture needle at the interface between the horizontal and vertical lines at a 30-45° angle, simultaneously palpating the pulsation of the femoral artery. After TFCA was completed, femoral artery angiography was performed in the anteroposterior and oblique directions. Clinical and radiological parameters, including CFA cannulation, the ultrasound scan time, the first pass success rate, the time required for the passage of the wire, and complications, were evaluated.
RESULTS
The mean ultrasound scan time of the CFA and its bifurcation was 72.6 seconds, and the mean time between administration of local anesthesia and wire passage was 67.44 seconds. The first pass success rate was 77.8% (70/90 patients), and the CFA puncture rate was 98.8% (89/90 patients). Although minor complications were noted in 7 patients, no patient reported serious complications (a large hematoma [≥ 5 cm], pseudoaneurysms, dissection, and/or a retroperitoneal hematoma.)
CONCLUSION
Prepuncture ultrasound examination might be a simple, safe, and accurate technique for cannulation of the CFA during TFCA.

Keyword

Cerebral angiography; Ultrasound; Femoral artery

MeSH Terms

Anesthesia, Local
Aneurysm, False
Angiography
Catheterization
Cerebral Angiography*
Femoral Artery*
Hematoma
Humans
Methods
Needles
Punctures
Skin
Ultrasonography*

Figure

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  Fig. 1 Prepuncture ultrasound images obtained in the angiography room. (A) A transverse view showing the common femoral artery (CFA) bifurcation (white arrow). (B) A longitudinal view showing the CFA (arrowhead) and the CFA bifurcation (white arrow). (C) Cruciate lines are marked on the skin based on the findings of an ultrasound examination. The transverse line indicates the level of the CFA bifurcation (white arrows), and the longitudinal line indicates the direction of the CFA (arrowheads). (D, E) Anteroposterior (D) and oblique (E) views of the radiopaque device placed at the junction of the cruciate lines after draping the inguinal area. The relation between the femoral head and femoral artery bifurcation is confirmed with the images. (F, G) Anteroposterior (F) and oblique (G) views obtained after femoral artery puncture and passage of the guide-wire. The femoral artery puncture point (white arrow) is confirmed using fluoroscopy.

• 

  Fig. 2 Femoral artery angiography images. (A, B) Anteroposterior (A) and oblique (B) views. The virtual line between the anterior superior iliac spine (ASIS) and the pubic tubercle is considered the inguinal ligament. The common femoral artery (CFA) length is measured between the inguinal ligament and the CFA bifurcation (white arrow). The sheath insertion point (arrowhead) is located within the CFA.

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