Transradial versus transfemoral access for cardiac catheterization: a nationwide pilot study of training preferences and expertise in The United States

Khalid Changal,Asad Inayat,F N U Salman,Salik Nazir,Sameer Saleem,Ealla Atari,Mubbasher Ameer Syed,Ehab Eltahawy,Sajjad Gul

doi:10.1186/s12872-021-02068-5

Abstract

BackgroundThe objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. As TRA continues to dominate the field of interventional cardiology, there is a concern that trainees may become less proficient with the femoral approach.MethodsA detailed questionnaire was sent out to academic General Cardiovascular and Interventional Cardiology training programs in the United States. Responses were sought from fellows-in-training and faculty regarding preferences and practice of TFA and TRA. Answers were analyzed for significant differences between trainees and trainers.ResultsA total of 125 respondents (75 fellows-in-training and 50 faculty) completed and returned the survey. The average grade of comfort for TFA, on a scale of 0 to 10 (10 being most comfortable), was reported to be 6 by fellows-in-training and 10 by teaching faculty (p < 0.001). TRA was the first preference in 95% of the fellows-in-training compared to 69% of teaching faculty (p 0.001). While 62% of fellows believed that they would receive the same level of training as their trainers by the time they graduate, only 35% of their trainers believed so (p 0.004).ConclusionThe shift from TFA to radial first has resulted in significant concern among cardiovascular fellows-in training and the faculty regarding training in TFA. Cardiovascular training programs must be cognizant of this issue and should devise methods to assure optimal training of fellows in gaining TFA and managing femoral access-related complications.

Highlights

The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States
The questionnaire was emailed to 239 academic General Cardiovascular and 160 Interventional Cardiology training programs in the United States that were listed on FREIDA [Fellowship and Residency Electronic Interactive Database] (Fig. 1)
While 24% of teaching faculty were comfortable enough with TFA that ultrasound guidance for it was not utilized, only 2% of fellows-in-training felt the same (p < 0.001)

Summary

Introduction

The objective was to assess current training preferences, expertise, and comfort with transfemoral access (TFA) and transradial access (TRA) amongst cardiovascular training fellows and teaching faculty in the United States. Over the last 30 years, multiple observational and randomized studies comparing TFA and TRA have reported lower rates of bleeding and vascular complications with TRA [1, 5,6,7,8,9,10,11,12,13,14]. The decreased access site bleeding was shown to lower mortality in multiple subsets of patients undergoing PCI via TRA [1, 9,10,11, 15,16,17,18,19,20,21,22,23,24,25,26]. TRA was shown to reduce time to ambulation, improve patient comfort, and decrease overall costs and length of hospital stay [10, 16, 27,28,29,30,31,32,33,34,35,36,37,38]

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