Background Anatomic variations in the spatial relationship between the femoral vein and artery are recognized as predisposing factors for iatrogenic vascular injury during percutaneous procedures. There have been few clinical studies comparing different directions of femoral vein puncture. Here, we conducted a prospective randomized controlled trial comparing two directions of femoral vein puncture. Methods A cohort of patients undergoing percutaneous femoral venous catheterization was randomized into two groups of comparable size, with punctures executed via either the lateral or orthogonal approach. The primary outcome was the first‐attempt success rate. Secondary outcomes included overall success rate, number of puncture attempts, puncture time, and complications. Results Among 108 patients, the lateral approach group demonstrated a higher first‐attempt success rate (76% vs. 52%; risk difference: 24%, 95% CI: 6% to 40%; p = 0.009) and overall success rate (91% vs. 61%; risk difference: 30%, 95% CI: 14% to 45%; p < 0.001), fewer puncture attempts ( p = 0.004), and a shorter puncture time (median difference: −6.0 s, 95% CI: −13.0 to 0.0; p = 0.042). The advantages of the lateral approach were more significant when there was a lumen overlap between the femoral vein and artery. There were similar complication rates between approaches. Conclusions When relying on anatomical landmarks for femoral vein puncture, the lateral approach is conducive to improving the success rate and reducing operating time without raising the risk of local complications. This is particularly beneficial in cases where the femoral artery and vein partially or fully overlap. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2500096775
Liu et al. (2026) studied this question.