Comparison of a 21G Micropuncture Needle and a Regular 19G Access Needle for Antegrade Arterial Access into the Superficial Femoral Artery

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Abstract
The purpose of this prospective study was to compare a 21G micropuncture needle with a regular 19G access needle for direct superficial femoral artery (SFA) access. A total of 100 consecutive patients were randomized to each group. Ultrasound-guided antegrade puncture of the SFA was performed using either a 21G or 19G needle. The time between injection of local anesthesia and flushing of the inserted sheath was measured. For hemostasis, either manual compression for 20 min or a closure device was used. All patients received an ultrasound exam 6 h after the procedure to assess the puncture site. Successful access was achieved in 49 of 50 (98 %) in the 21G group and 50 of 50 (100 %) in the 19G group. In one patient, access with the 21G failed due to severe calcification. Access was successful after switching to the 19G needle. Immediate hemostasis was achieved in all patients. Overall, 22 complications were observed: 10 pseudoaneurysms (4 using the 21G and 6 with the 19G) and 12 hematomas (9 with the 21G and 3 with the 19G). The differences were not statistically significant (p > 0.05). Time to access was significantly faster for the 19G needle (median time 205 s; range: 94–2,160 s) compared with the 21G needle (median time 330 s; range: 93–1,140 s; p = 0.002). The rate of pseudoaneurysms after SFA access was slightly lower using a 21G needle compared with a 19G needle; however, this was without statistical significance. On the other hand, there was an increase in access time and hematomas with the 21G needle.

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