Usefulness of ultrasonography to confirm hemostasis after femoral artery access in endovascular therapy

TL;DR

Using ultrasound to check for proper blood clotting after artery procedures reduces complications, especially with larger tools.

Contribution

This study shows that using ultrasound to confirm hemostasis after femoral artery access improves outcomes in endovascular therapy.

Findings

Ultrasound-confirmed hemostasis reduced bleeding complications with 6 Fr sheaths.

Pseudoaneurysm formation was less common in the ultrasound group with 6 Fr sheaths.

No significant difference in complications was found with 5 Fr or smaller sheaths.

Abstract

Femoral artery access is commonly used in endovascular therapy (EVT) for peripheral artery disease (PAD), but puncture site complications remain a significant concern. Although manual compression is widely applied, assessment of hemostasis is often subjective. Routine ultrasonographic confirmation of hemostasis may provide a more objective evaluation, but its clinical impact has not been fully clarified. The purpose of this study is to investigate the association between ultrasonography-confirmed hemostasis and femoral artery access site complications following EVT for PAD.

This single-center retrospective cohort study analysed 1643 femoral artery access sites in patients undergoing EVT for PAD between January 2018 and August 2025. Until December 2019, hemostasis was assessed based on clinical judgement alone, whereas from January 2020 onward, routine ultrasonographic confirmation of hemostasis was implemented as an institutional protocol. Access sites were categorized into an ultrasonography group (n = 1185) and a non-ultrasonography group (n = 458). A 1:1 propensity score matching analysis yielded 429 matched access sites in each group. The primary endpoint was access site bleeding complications, defined as persistent or recurrent bleeding, hematoma formation, or pseudoaneurysm development during or after compression with a pressure bandage.

In the matched cohort, ultrasonography-confirmed hemostasis was associated with a significantly lower incidence of bleeding complications when 6 Fr sheaths were used (3.5% vs. 7.7%, p = 0.022). The incidence of pseudoaneurysm formation was also lower in the ultrasonography group with 6 Fr sheaths (0.95% vs. 3.5%, p = 0.029). No significant differences in bleeding complications were observed between groups when 5 Fr or smaller were used. Within the ultrasonography group, bleeding complication rates did not differ between antegrade and retrograde femoral access approaches.

Routine ultrasonographic confirmation of femoral artery hemostasis was associated with fewer access site bleeding complications after EVT for PAD, particularly when larger (6 Fr) sheaths were used. Ultrasonographic evaluation may represent a simple and effective strategy to enhance procedural safety in femoral artery EVT.

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