Influence of operator experience and PCI volume on transfemoral access techniques: A collaboration of international cardiovascular societies

Introduction: Transfemoral access (TFA) is widely used for coronary angiography and percutaneous coronary intervention (PCI). The influence of operator age, gender, experience, and procedural volume on performance of femoral arterial access has not been studied. Methods: A survey instrument was developed and distributed via e-mail from professional societies to interventional cardiologists worldwide from March to December 2016. Results: A total of 988 physicians from 88 countries responded to the survey. TFA is the preferred approach for patients with cardiogenic shock, left main or bifurcation PCI, and procedures with mechanical circulatory support. Older (< 50 years: 56.4%; ≥ 50 years: 66.8%, p < 0.0039) and high PCI volume operators (< 100 PCI: 57.3%; 100–299 PCI: 58.7%; ≥ 300 PCI: 64.3%, p < 0.134) preferred palpation only without imaging (fluoroscopy or ultrasound (US)) for TFA. Most respondents preferred not to use micropuncture needle to puncture the femoral artery. Older (≥ 50 years: 64.4%; < 50 years: 71.5%, p < 0.04) and high PCI volume operators (≥ 300 PCI: 64.1%; 100–299 PCI: 72.6%; < 100 PCI: 67.9%, p < 0.072) tended not to perform femoral angiography (FA). Of those performing FA, the majority opted to do it at the end of the procedure. Conclusion: Despite best practice guideline recommendations, older and high PCI volume interventional cardiologists prefer not to use imaging for femoral access or perform femoral angiography during TF procedures. These data highlight opportunities to further reduce TFA complications.