A Lesson from Cardiology: The Argument for Ultrasound-Guided Femoral Artery Access in Interventional Neuroradiology

Purpose: The transfemoral approach is widely used by neurointerventionalists for accessing the femoral artery in patients undergoing diagnostic and therapeutic endovascular procedures. In patients with more difficult anatomy, duplex ultrasonography (US) may be a valuable adjunct for femoral vascular access. We aimed to assess the evidence for the effectiveness of duplex US–guided femoral access within interventional neuroradiology. Methods: We searched MEDLINE, Scopus, and EMBASE and included 5 randomized controlled trials. Odds ratios (ORs) and mean differences were pooled using the random-effects model. Results: Meta-analysis of 5 RCTs that included 784 US-guided patients and 769 non–US-guided patients found that the US-guided approach was significantly favored in terms of time-to-access (weighted mean difference: 24.90 minutes, 95% confidence interval [CI] 12.41–37.38), first-pass success rate (OR 2.97; 95% CI 1.49–5.92), and total complication rate (OR 0.42, 95% CI 0.23–0.77). There were no statistically significant differences in technical success rate, number of attempts, or individual complications. Conclusions: US-guided femoral artery access for endovascular procedures is a safe and effective adjunct for visualizing the femoral artery during vascular access for endovascular procedures. Neurointerventionalists should consider a low threshold for its use, especially for patients with challenging anatomy or at high-risk of bleeding complications.