الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vascular access continues to be the one of the most important and delicate steps in performing angiographic procedures. Multiple attempts have only partially succeeded at making this step easier, safer and reproducible. The common femoral artery (CFA) is the most commonly used vessel to obtain arterial access during percutaneous coronary angiography. Ideally, the anterior wall of the CFA should be punctured 1–2 cm below the inguinal ligament but proximal to its bifurcation into the superficial femoral and profunda arteries. This is important to facilitate vessel entry and avoid complications. Punctures of the superficial femoral artery or the profunda artery (i.e., puncture below the bifurcation of the CFA) are more likely to lead to the formation of pseudoaneurysms; conversely, an arterial puncture above the inguinal ligament is associated with a higher incidence of retroperitoneal bleeding .Anatomic landmarks have been utilized to identify the CFA including the inguinal skin crease, maximal femoral pulse, and bony landmarks. Because of a consistent radiographic relationship between the course of the CFA and the femoral head, it has been postulated that fluoroscopic guidance (FG) could be of value when attempting to access the CFA .
The aim of the work is to compare the effectiveness of accessing the common femoral artery (CFA) using fluoroscopic guidance (FG) versus traditional anatomic landmark guidance (TALG) during cardiac catheterization and to determine the effect of the two modalities on vascular complications.
All patients undergoing elective cardiac catheterization from the femoral approach were eligible for inclusion in the trial. Subjects who met all enrollment criteria and signed the informed consent were randomized into this study,
A total of 500 patients were randomized to either FG or TALG access. The primary endpoint of the study was the success in accessing the CFA as determined by femoral angiography. Secondary endpoints included time and number of attempts needed to obtain access, first pass success rate and the incidence of vascular complications.
The results of these, 250 patients were randomized into the FG arm and 250 patients into the TALG arm. A total of 98.8% of patients in the fluoroscopy arm and 94.2% in the traditional arm (P 0.10) had successful CFA access especially in patients with BMI ≥ 30. The fluoroscopy group had significantly less number of attempts and higher first pass success rate (P 0.007, 0.019) especially in patients with previous cardiac catheterization from the ipsilateral femoral artery and those with BMI≥30. Total time for sheath insertion (51.68 ± 9.84 sec)vs (40.56 ± 8.51) and number of arterial punctures (1.02 0.2 vs. 1.09 0.34.) was significantly less among the FG group , respectively. The rates of vascular complications were significantly higher in TALG group but not major vascular complications. The use of anatomic landmark guidance without the use of fluoroscopy is a significant risk factor for vascular complications. It increases the risk 3 times.
Our study has revealed that fluoroscopic guided access was superior to anatomic landmark guidance in accessing the CFA, technical success (number of attempts and first pass success) and prevention of vascular complications. Obese patients and those with previous catheterization are two categories that benefited the most from the use of fluoroscopy, with higher CFA access and first pass in obese, and higher first pass in previous catheterization patients.