Ultrasound is not the panacea for transfemoral access complications

Compared to radial access, femoral access has been shown to increase bleeding and vascular complications in stable ischaemic heart disease and even mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI)1. However, transfemoral access (TFA) remains necessary for larger-bore complex procedures and in cases of radial access failure2. Precise cannulation of the common femoral artery is essential, as punctures higher than the inguinal ligament increase the risk for retroperitoneal haemorrhage, while punctures below the femoral bifurcation increase the risk for pseudoaneurysms, arteriovenous fistulas and acute limb ischaemia2. Ultrasound (US) guidance has emerged as an effective adjunct to increase TFA safety and procedural efficacy. The recent Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures: a Randomized Trial (UNIVERSAL) did not demonstrate a benefit of US guidance over no US guidance for TFA regarding access site complications3. However, a follow-up meta-analysis suggested a benefit based on the totality of the evidence4.

In this issue of EuroIntervention, Meijers et al report the results of the Ultrasound Guided Transfemoral Large-bore Trial (ULTRACOLOR), in which 554 patients undergoing...