Ultrasound-guided Femoral Vascular Access in Adult Congenital Heart Disease Patients Undergoing Catheter Ablation

Background: Vascular complications are the most common complications in adult congenital heart disease (ACHD) patients undergoing catheter ablation for cardiac arrhythmias. Femoral vascular access using a standard anatomical landmark-guided approach is often complicated in this patient group due to complex vascular anatomy or previous catheter interventions or cardiac surgery with femoral cannulation. Data on the feasibility of ultrasound-guided vascular access in ACHD patients undergoing catheter ablation are scarce. We therefore compared an ultrasound-guided vascular puncture approach (UGVP) with a standard approach with regard to vascular complications.

Methods: A total of 477 consecutive ACHD patients (52% male, mean age 46 ± 14 years) with simple (n = 166), moderate (n = 133), or complex (n = 178) congenital heart disease who underwent 639 catheter ablation procedures were included. Femoral vascular access complications were compared between 243 patients (51%) with 271 ablations (42%) undergoing UGVP and 234 patients (49%) with 368 ablations (58%) undergoing a conventional vascular access (CVA) approach. Baseline characteristics including age, gender, BMI, arterial hypertension, diabetes, history of stroke or coronary artery disease were not different between the groups (p > 0.05).

Results: Major vascular access complications including retroperitoneal hematoma and arteriovenous (AV) fistula requiring surgical treatment occurred in four cases from the conventional group (4/368 cases; 1%) and no case from the UGVP group (0/271 cases; 0%). Minor vascular access complications were detected in 57/639 cases (8.9%): hematomas >5 cm (CVA n = 26 vs. UGVP n = 3), AV fistulas treated conservatively (CVA n = 13 vs. UGVP group n = 4), and pseudoaneurysms treated by manual compression or ultrasound-guided thrombin injection (CVA n = 7 vs. UGVP n = 4). UGVP significantly reduced the minor vascular access complications compared with the standard approach (4.1% vs. 12.5%; p < 0.01).

Conclusion: Ultrasound-guided femoral vascular access is a safe and easy-to-use method that significantly decreases major and minor vascular access complications in ACHD patients undergoing catheter ablation.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025