Comparison of ultrasound-guided versus landmark-guided femoral artery access in coronary angiography: a single-centre experience

Background: Sometimes the femoral artery is still used to do coronary angiography. The traditional approach to femoral artery access is landmark guided, but recently ultrasound guided is gaining interest as it may minimize vascular complications and enhance procedural success. This study aimed to evaluate and compare the feasibility of ultrasound-guided with landmark-guided approach to reach the femoral artery during coronary angiography. Study Design: Comparative cross-sectional study. Place and Duration of Study: This study was conducted in the Department of Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from November 2025 to April 2026. Methods: The total number of patients with coronary angiography that participated in the study was 288. The number of samples was determined using the World Health Organisation-suggested formula. Patients were divided into two groups with respect to the vascular access technique: the ultrasound guided femoral artery access group (UFA) and the landmark guided femoral artery access group (LFA). The following demographic data, presence of hematoma, bleeding and arterial injury were documented and analysed using SPSS version 26 and the first-attempt success rate, access time, number of puncture attempts and vascular complications were. Results: The ultrasound-guided femoral artery access technique had higher success rates and shorter access times in the first attempt, compared to the landmark-guided technique. There were also fewer attempts at puncture and fewer vascular complications in the ultrasound assisted group, with significantly fewer hematoma and bleeding. Conclusion: The ultrasound-guided femoral artery approach is more successful and is less associated with vascular complications in coronary angiography as compared to the landmark approach.