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Survey: Transfemoral access techniques vary widely
New data from an international survey indicate significant variation in techniques and practices of transfemoral access for coronary angiography and PCI.
Of the 987 operators from 88 countries who responded to the survey, 60% preferred using pulse palpation alone for the transfemoral technique, whereas 11% preferred fluoroscopy guidance and 27% preferred a combination of palpation, fluoroscopy or ultrasound.
Respondents who identified themselves as femoralists were more likely to prefer pulse palpation alone without imaging guidance and were more likely to use a large sheath size during diagnostic and interventional procedures, according to the data. Additionally, only 11% of respondents used a micropuncture needle more than 90% of the time, the researchers noted.
Results also showed that 23% of respondents preferred performing femoral angiography immediately after access, 47% preferred performing angiography at the end of the procedure and 31% preferred not performing it at all.
For hemostasis, 50% of respondents preferred manual compression, 31% preferred a collagen plug vascular closure device and 11% preferred a suture-based vascular closure device, according to the data.
In addition, nearly all operators preferred the Judkins left and right catheters to engage the left (99%) and right (94%) coronary arteries for diagnostic angiography. For PCI, many operators preferred extra backup curves of the left anterior descending (80%) and left circumflex (80%) arteries, but 86% preferred the Judkins right catheter for the right coronary artery.
For this study, Abdulla A. Damluji, MD, MPH, from the Sinai Hospital of Baltimore and LifeBridge Health Cardiovascular Institute and Johns Hopkins University, and colleagues created an internet-based survey and used email lists from interventional cardiology societies and educational courses focused on CV interventions to contact potential respondents.
Of those who responded, 18% identified themselves as femoralists, 38% as radialists, 42% as both and 2% as neither. Most respondents were from Europe (26%) and North America (21%).
In an accompanying editorial, Ian C. Gilchrist, MD, from the Penn State University College of Medicine and M.S. Hershey Medical Center in Pennsylvania, highlighted the challenges of performing internet-based surveys, including low response rates, uncertainties about potential biases and the relative immaturity of the science of such surveys.
However, Gilchrist noted that internet surveys offer an interesting way to gain insight into real-world practice. The study indicates that the practice of femoral access may be suboptimal and departs from the currently available guidelines, according to Gilchrist.
“This is an important study, as it is a canary in the coal mine pointing to a significant unmet need for education in modern femoral artery access techniques, and it provides impetus for quality improvement to improve the use of ultrasound imaging and other techniques to enhance vascular access,” he wrote. – by Melissa Foster
Disclosures: Damluji and Gilchrist report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.