VARIABILITY IN TRANSFEMORAL ACCESS FOR CORONARY ANGIOGRAPHY AND INTERVENTIONS: RESULTS FROM AN INTERNATIONAL SURVEY

Abstract

Background: Variability in femoral arterial access technique for coronary procedures remains largely unknown. Methods: We developed a survey instrument that was distributed via e-mails lists from professional societies to interventional cardiologists from 88 countries between March-October 2016. Results: Of 988 operators, 18% considered themselves femoralists, 38% radialists, and 42% used both access techniques equally. Access using femoral pulse palpation alone was preferred by 60% operators, fluoroscopy guidance by 11%, and ultrasound by 2% (Figure 1-2). Mictropuncture needles were used more than 90% of time by only 11% of operators. Femoral angiograms are usually performed immediately after access by 22%, at the end of the procedure by 46%, and not at all by 29% operators. Hemostasis by manual compression was preferred by 48%, Angioseal by 34%, and Perclose by 11% operators. Judkins left and right catheters were preferred for diagnostic angiography of the left (99%) and right (96%) coronary arteries. Extra backup curves (XB or EBU) were most commonly preferred for PCI of the left anterior descending (80%) and left circumflex (80%) whereas the Judkins right was preferred for PCI of the right coronary artery (86%). Most operators surveyed in North America and Europe believed that their TFA practices will stay the same and those in Asia and South America believed that their TFA practices will decrease overtime (Figure 3). Conclusion: There is significant variability in femoral access techniques. Even though recommended best practices advocate for the fluoroscopic and ultrasound guidance, most operators use palpation alone. The consequences of lack of adoption of imaging guidance for vascular access deserve further investigation.