Ultrasound is not the panacea for transfemoral access complications
Bibliographic record
Abstract
ompared to radial access, femoral access has been shown to increase bleeding and vascular complications in stable ischaemic heart disease and even mortality in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) 1 .However, transfemoral access (TFA) remains necessary for larger-bore complex procedures and in cases of radial access failure 2 .Precise cannulation of the common femoral artery is essential, as punctures higher than the inguinal ligament increase the risk for retroperitoneal haemorrhage, while punctures below the femoral bifurcation increase the risk for pseudoaneurysms, arteriovenous fistulas and acute limb ischaemia 2 .Ultrasound (US) guidance has emerged as an effective adjunct to increase TFA safety and procedural efficacy.The recent Routine Ultrasound Guidance for Vascular Access for Cardiac Procedures: a Randomized Trial (UNIVERSAL) did not demonstrate a benefit of US guidance over no US guidance for TFA regarding access site complications 3 .However, a follow-up meta-analysis suggested a benefit based on the totality of the evidence 4 .In this issue of EuroIntervention, Meijers et al report the results of the Ultrasound Guided Transfemoral Large-bore Trial (ULTRACOLOR), in which 554 patients undergoing complex PCI mandating large-bore (≥7 Fr) TFA were randomised to US guidance versus fluoroscopy guidance for the primary outcome of major bleeding (Bleeding Academic Research Consortium [BARC] 2, 3 or 5) or vascular complications during the index hospitalisation 5 .The median age was 71 years, 76% of participants were male, and 68% underwent a chronic total occlusion PCI.The authors demonstrated that US guidance did not decrease the incidence of the primary outcome in the US-guided TFA group as compared to the fluoroscopy-guided TFA group (43/274 [15.7%] vs 51/270 [18.9%]; p=0.32).However, US guidance was associated with a higher rate of first-pass success as compared to fluouroscopy guidance (251/274 [92%] vs 230/270 [85%]; p=0.02). Article, see page e876
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.041 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.007 |
| Insufficient payload (model declined to judge) | 0.012 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".