Ultrasound versus manual guided femoral vascular access in pediatric cardiovascular interventions: A prospective comparative study

Femoral vascular access is the most commonly used route for pediatric cardiac interventions; however, its technical difficulty increases the risk of access-related complications. Ultrasound (USG) guidance has the potential to improve procedural safety and efficiency. Primary outcomes were puncture attempts and vascular complications; secondary outcomes included crossover rates and risk factors for complications. This prospective, single-center study included 66 patients undergoing 90 femoral vascular accesses for diagnostic or therapeutic cardiovascular interventions. Patients were assigned to the USG or manual-guided groups in an alternating order. The pediatric cardiologist performed manual vascular access procedures, while the interventional radiologist performed USG-guided procedures. A total of 40 procedures were performed under USG guidance, and 50 under manual access. The mean number of puncture attempts was significantly lower in the USG group (1.50 ± 0.93) than in the manual group (2.38 ± 1.90; p = 0.009). In the subgroup analysis, the difference reached statistical significance for venous interventions (p = 0.04) but not for arterial interventions (p = 0.088). Overall complication rate was 7.5% in the USG group versus 22% in the manual group (p = 0.08). The major complication rate was 3.3%, and all of them occurred in the manual group. Most crossover cases were successfully rescued with USG guidance, predominantly in infants under one year of age. USG-guided femoral access in children significantly reduces the number of puncture attempts. This technique has the potential to reduce access-related complications, especially in infants.