Table 2 Transfemoral Vs. Transradial access practices in Fellows-in-Training and teaching faculty
Variable | Total % (n) | Trainee % (n) | Trainer % (n) | P value |
|---|---|---|---|---|
Use of ultrasound for gaining TRA | ||||
US TRA every case | 14 (15) | 18 (11) | 8 (4) | 0.16 |
US only if initial assessment hints difficulty | 43 (47) | 44 (27) | 41 (20) | 0.72 |
US if pulse guided access fails once or twice | 34 (37) | 31 (19) | 37 (18) | 0.54 |
Never | 10 (11) | 6.5 (4) | 14 (7) | 0.18 |
Use of ultrasound for gaining TFA | ||||
US TFA every case | 50 (55) | 56 (34) | 43 (21) | 0.18 |
If initial assessment hints difficult access | 22 (24) | 26 (16) | 16 (8) | 0.2 |
If pulse guided access fails once or twice | 16 (18) | 16 (10) | 16 (8) | 0.9 |
Never | 12 (13) | 2 (1) | 24 (12) | < 0.001 |
Percentage of TFAs on an average day in the catheterization lab | ||||
Average TFA per day (Mean percent) | 34.4 | 34 | 35 | 0.58 |
Grade of expertise and comfort with access [Scale of 1–10; 10 being expert] | ||||
Self-graded expertise and comfort for TRA | 8 | 7 | 9 | < 0.001 |
Self-graded expertise and comfort for TFA | 7.8 | 6 | 10 | < 0.001 |
Witnessed and managed TFA-related complications in preceding 12 months | ||||
Less than 5 | 38 (42) | 33 (20) | 45 (22) | 0.19 |
5–10 | 43 (47) | 46 (28) | 39 (19) | 0.45 |
11–15 | 11 (12) | 13 (8) | 8 (4) | 0.41 |
16–20 | 3 (3) | 5 (3) | 0 (0) | 0.25 |
More than 20 | 5 (6) | 3 (2) | 8 (4) | 0.26 |
Preferred Access | ||||
TFA first | 16 (18) | 5 (3) | 31 (15) | 0.001 |
TRA first | 84 (92) | 95 (58) | 69 (34) | 0.001 |
Reason for preference of access | ||||
Associated risk factor profile of access | 72 (79) | 75 (46) | 67 (33) | 0.35 |
Seen/done/taught more | 49 (54) | 62 (38) | 33 (16) | 0.002 |
Ability to maneuver | 20 (22) | 9 (5) | 35 (17) | 0.001 |
Preservation of radial conduits | 3 (4) | 0 (0) | 8 (4) | 0.04 |
Ability to upsize to larger bore | 13 (14) | 3 (2) | 24 (12) | 0.001 |
Ease of closure | 64 (70) | 69 (42) | 57 (28) | 0.20 |
Patient satisfaction | 75 (83) | 85 (52) | 63 (31) | 0.008 |
Training center “radial first” policy | 40 (44) | 51 (31) | 26 (13) | 0.01 |
High exposure to radial arterial lines | 12 (13) | 20 (12) | 2 (1) | 0.006 |
Low exposure to femoral arterial lines | 12 (13) | 21 (13) | 0 (0) | 0.001 |
Future of TFA | ||||
Will remain just as frequent & viable | 17 (19) | 18 (11) | 16 (8) | 0.81 |
Will be entirely replaced | 3 (3) | 3 (2) | 2 (1) | 1.0 |
Frequency will reduce but will remain viable for certain cases | 80 (88) | 79 (48) | 82 (40) | 0.70 |
Do you believe you [they] will get the same level/expertise of TFA training as your predecessors by the time you [they] graduate? | ||||
Yes | 50 (55) | 62 (38) | 35 (17) | 0.004 |
Are you concerned about the quality/quantity of TFA training? | ||||
Yes very | 23 (25) | 11 (7) | 37 (18) | 0.002 |
Yes somewhat | 34 (37) | 36 (22) | 31 (15) | 0.54 |
Not concerned, satisfied | 41 (45) | 51 (31) | 28 (14) | 0.02 |
No, exposure is declining but TFA will soon be irrelevant | 1.8 (2) | 1.6 (1) | 2 (1) | 1.0 |
Validity of the proposed “Campeau Radial Paradox” | ||||
Believe the paradox is Valid | 63 (69) | 61 (37) | 65 (32) | 0.62 |