Study Supports Ultrasound-Guided Access for CLI Treatment

June 1, 2013—A single-center study of the utility and feasibility of ultrasound-guided access in patients with critical limb ischemia (CLI) was published by J.A. Mustapha, MD, et al in Catheterization and Cardiovascular Interventions (2013;81:1204–1211).

The investigators concluded that ultrasound-guided access is a feasible and safe procedure that can aid in accessing vascular conduits in patients with CLI and that applying this technique across the board in CLI patients decreases the risk of immediate complications and facilitates accessing tibial arteries.

According to the investigators, patients with advanced peripheral vascular disease and CLI require immediate revascularization to improve blood flow and prevent amputation; vascular access, especially tibial access, is arguably a very important part of the procedure. The investigators sought to demonstrate that utilization of ultrasound guidance to access the peripheral vessels will maximize success and decrease the risk of complications.

As summarized in Catheterization and Cardiovascular Interventions, the investigators conducted a retrospective analysis of patients admitted to their institution—Metro Health Hospital in Wyoming, Michigan—between 2010 and 2011. Eighty-six patients with 191 lesions underwent revascularization for advanced peripheral vascular disease and CLI. Ultrasound guidance was used to access the vascular bed in an antegrade or retrograde fashion in 100% of these patients. Data collected included success rate and time to access using ultrasound. Immediate in-hospital and 30-day outcomes were also documented.

In the study, the average age of patients was 69.8 years, with 69.7% male patients. All tibial access (33.7%) was obtained under ultrasound guidance. Vascular access using ultrasound was achieved in 95.3% of patients. At discharge, access site complications were limited to one patient (1.1%) with a pseudoaneurysm; no access complications were related to the tibial vessels. At 30 days, there was one major amputation (1.1%) and one vascular access complication (1.1%), reported the investigators.