Non-Ultrasound-Guided Versus Ultrasound-Guided Femoral Venous Puncture in the Interventional Pulmonary Embolism Era: Does Ultrasound Guidance Improve Safety and Feasibility?

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Abstract
Background: The use of interventional endovascular therapy for pulmonary embolism (PE) has become increasingly important over the last decade. In contrast to other cardiovascular interventions, these procedures carry a higher risk of access-related bleeding due to the acute clinical setting, elevated body mass index, and the frequent need for high-dose anticoagulation. However, there is still no clear consensus regarding the optimal vascular access site for endovascular PE therapy or the impact of ultrasound (US)-guided puncture on access-related complications. Methods: We treated 89 patients with intermediate- to high-risk PE using the Ekosonic endovascular system (EKOS). Group A (n = 39) underwent femoral venous puncture without US guidance, and Group B (n = 50) underwent US-guided femoral venous puncture. Results: Intraprocedural complications differed significantly between the two groups, with a higher incidence of vascular access complications in the non-US-guided group. Access-site pseudoaneurysms and retroperitoneal bleeding events occurred exclusively in the non-US-guided group (n = 6). Major (n = 3) and moderate (n = 5) bleeding events were also observed only in the non-US-guided group (p < 0.001). However, the total length of stay in the intermediate care unit and in the hospital did not differ between the groups. These findings are consistent with prior reports from other interventional settings that demonstrate fewer bleeding events among patients undergoing US-guided procedures. Conclusion: Widespread adoption of US-guided puncture in interventional PE therapy could reduce access-related complications, increase first-pass success, and reduce the number of puncture attempts, inadvertent arterial punctures, and unsuccessful access-site cannulations, particularly in patients with unfavorable access anatomy, obesity, or anatomical variations. Further education and implementation of US-guided access into training programs could improve the adoption of this technique.

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