Ultrasound‑guided venous access facilitated by the Valsalva maneuver during invasive electrophysiological procedures

BACKGROUND: Data on the feasibility of an ultrasound‑guided venous access (USGVA) for catheter ablation (CA) and electrophysiological studies (EPS) in large cohorts are scarce. The impact of the Valsalva maneuver (VM), which can increase the diameter of the femoral vein (FV), on the USGVA is unknown. AIMS: The study aimed to determine the impact of the VM on FV diameters during establishing the USGVA and overall safety and effectiveness profile of the USGVA in a large cohort. METHODS: Consecutive patients undergoing CA and/ or EPS with the USGVA were included, and those with anatomical landmark–guided VA were recruited as controls. In a subgroup of USGVA patients, a VM‑facilitated FV puncture was performed. The measurements obtained before and during the VM were used to calculate the estimated access area (EAA) of the FV RESULTS: A total of 1564 ultrasound-guided FV accesses in 876 patients and 172 FV accesses in 105 patients in the anatomical‑VA group were performed. We observed no major complications associated with the USGVA. Minor adverse events related with VA were less common in the USGVA group than in controls (1.5% vs 6.7%, respectively; P = 0.001), resulting in a 4‑fold decrease in VA‑related complications. In 204 consecutive patients who underwent the VM‑facilitated USGVA, the FV diameters increased during VM in both vertical (mean [SD], 10.1 [3] mm vs 14.4 [3.2] mm; P <0.001) and horizontal axes (10.6 [2.9] mm vs 14.5 [3.2] mm; P <0.001). This led to the mean (SD) increase in EAA of 38%: from 0.8 (0.2)cm2 at baseline to 1.1 (0.2) cm2 during VM (P <0.001). CONCLUSIONS: The USGVA for EPS and/ or CA is feasible. Complication rates for the USGVA are low and result in minor events. The Valsalva maneuver is a simple way to remarkably increase the femoral vein EAA and it can be helpful in performing the USGVA in difficult cases.