Abdulla A Damluji1, Daniel W Nelson2, Marco Valgimigli3, Stephan Windecker3, Robert A Byrne4, Fernando Cohen5, Tejas Patel6, Emmanouil S Brilakis7, Subhash Banerjee8, Jorge Mayol9, Warren J Cantor10, Carlos E Alfonso11, Sunil V Rao12, Mauro Moscucci13, Mauricio G Cohen14. 1. Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. 2. Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. 4. Deutsches Herzzentrum München, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. 5. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 6. Apex Heart Institute, Ahmedabad, India. 7. Minneapolis Heart Institute, Minneapolis, Minnesota. 8. Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical, Dallas, Texas. 9. Centro Cardiológico Americano, Sanatorio Americano, Montevideo, Uruguay. 10. Southlake Regional Health Centre, University of Toronto, Toronto, Canada. 11. Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. 12. Duke Clinical Research Institute, Durham, North Carolina. 13. Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. 14. Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: mgcohen@med.miami.edu.
Abstract
OBJECTIVES: The aim of this study was to examine the current practice and use of transfemoral approach (TFA) for coronary angiography and intervention. BACKGROUND: Wide variability exists in TFA techniques for coronary procedures. METHODS: The authors developed a survey instrument that was distributed via e-mail lists from professional societies to interventional cardiologists from 88 countries between March and December 2016. RESULTS: Of 987 operators, 18% were femoralists, 38% radialists, 42% both, and 2% neither. Access using femoral pulse palpation alone was preferred by 60% of operators, fluoroscopy guidance by 11%, and a combination of palpation, fluoroscopy, or ultrasound by 27%. Only 11% used micropuncture in >90% of their cases. Performing femoral angiography immediately after access was preferred by 23% and at the end of the procedure by 47%, and not done at all by 31% of operators. Hemostasis by manual compression was preferred by 50%, collagen plug vascular closure device by 31%, and suture-based vascular closure device by 11% of operators. Judkins left and right catheters were preferred for diagnostic angiography of the left (99%) and right (94%) coronary arteries. Extra backup curves (XB or EBU) were most commonly preferred for percutaneous coronary intervention of the left anterior descending (80%) and left circumflex (80%), whereas the Judkins right catheter was preferred for percutaneous coronary intervention of the right coronary artery (86%). CONCLUSIONS: There is significant variability in preferences for femoral access technique. Even though recommended best practices advocate for fluoroscopic and ultrasound guidance, most operators use palpation alone. Femoral angiography is also not consistently used despite guideline recommendations. The lack of adoption of imaging guidance for vascular access deserves further investigation.
OBJECTIVES: The aim of this study was to examine the current practice and use of transfemoral approach (TFA) for coronary angiography and intervention. BACKGROUND: Wide variability exists in TFA techniques for coronary procedures. METHODS: The authors developed a survey instrument that was distributed via e-mail lists from professional societies to interventional cardiologists from 88 countries between March and December 2016. RESULTS: Of 987 operators, 18% were femoralists, 38% radialists, 42% both, and 2% neither. Access using femoral pulse palpation alone was preferred by 60% of operators, fluoroscopy guidance by 11%, and a combination of palpation, fluoroscopy, or ultrasound by 27%. Only 11% used micropuncture in >90% of their cases. Performing femoral angiography immediately after access was preferred by 23% and at the end of the procedure by 47%, and not done at all by 31% of operators. Hemostasis by manual compression was preferred by 50%, collagen plug vascular closure device by 31%, and suture-based vascular closure device by 11% of operators. Judkins left and right catheters were preferred for diagnostic angiography of the left (99%) and right (94%) coronary arteries. Extra backup curves (XB or EBU) were most commonly preferred for percutaneous coronary intervention of the left anterior descending (80%) and left circumflex (80%), whereas the Judkins right catheter was preferred for percutaneous coronary intervention of the right coronary artery (86%). CONCLUSIONS: There is significant variability in preferences for femoral access technique. Even though recommended best practices advocate for fluoroscopic and ultrasound guidance, most operators use palpation alone. Femoral angiography is also not consistently used despite guideline recommendations. The lack of adoption of imaging guidance for vascular access deserves further investigation.
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