Transfemoral Approach for Coronary Angiography and Intervention: A Collaboration of International Cardiovascular Societies

Abdulla A. Damluji, Daniel W. Nelson, Marco Valgimigli, Stephan Windecker, Robert A. Byrne, Fernando Cohen, Tejas Patel, Emmanouil S. Brilakis, Subhash Banerjee, Jorge Mayol, Warren J. Cantor, Carlos E Alfonso, Sunil V. Rao, Mauro Moscucci, Mauricio G Cohen

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2269-2279
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume10
Issue number22
DOIs
StatePublished - Nov 27 2017

Fingerprint

Thigh
Coronary Angiography
Palpation
Angiography
Fluoroscopy
Percutaneous Coronary Intervention
Coronary Vessels
Catheters
Postal Service
Hemostasis
Punctures
Practice Guidelines
Sutures
Blood Vessels
Pulse
Collagen
Guidelines
Vascular Closure Devices

Keywords

  • PCI
  • stent
  • survey
  • transfemoral

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transfemoral Approach for Coronary Angiography and Intervention : A Collaboration of International Cardiovascular Societies. / Damluji, Abdulla A.; Nelson, Daniel W.; Valgimigli, Marco; Windecker, Stephan; Byrne, Robert A.; Cohen, Fernando; Patel, Tejas; Brilakis, Emmanouil S.; Banerjee, Subhash; Mayol, Jorge; Cantor, Warren J.; Alfonso, Carlos E; Rao, Sunil V.; Moscucci, Mauro; Cohen, Mauricio G.

In: JACC: Cardiovascular Interventions, Vol. 10, No. 22, 27.11.2017, p. 2269-2279.

Research output: Contribution to journalArticle

Damluji, AA, Nelson, DW, Valgimigli, M, Windecker, S, Byrne, RA, Cohen, F, Patel, T, Brilakis, ES, Banerjee, S, Mayol, J, Cantor, WJ, Alfonso, CE, Rao, SV, Moscucci, M & Cohen, MG 2017, 'Transfemoral Approach for Coronary Angiography and Intervention: A Collaboration of International Cardiovascular Societies', JACC: Cardiovascular Interventions, vol. 10, no. 22, pp. 2269-2279. https://doi.org/10.1016/j.jcin.2017.08.035
Damluji, Abdulla A. ; Nelson, Daniel W. ; Valgimigli, Marco ; Windecker, Stephan ; Byrne, Robert A. ; Cohen, Fernando ; Patel, Tejas ; Brilakis, Emmanouil S. ; Banerjee, Subhash ; Mayol, Jorge ; Cantor, Warren J. ; Alfonso, Carlos E ; Rao, Sunil V. ; Moscucci, Mauro ; Cohen, Mauricio G. / Transfemoral Approach for Coronary Angiography and Intervention : A Collaboration of International Cardiovascular Societies. In: JACC: Cardiovascular Interventions. 2017 ; Vol. 10, No. 22. pp. 2269-2279.
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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.",
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AU - Windecker, Stephan

AU - Byrne, Robert A.

AU - Cohen, Fernando

AU - Patel, Tejas

AU - Brilakis, Emmanouil S.

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AU - Mayol, Jorge

AU - Cantor, Warren J.

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N2 - 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.

AB - 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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