Adoption of Routine Ultrasound Guidance for Femoral Arterial Access for Cardiac Catheterization

Abstract

Background: A randomized controlled trial published in 2010 demonstrated that ultrasound-guided femoral artery access for coronary angiography was faster and associated with fewer vascular complications than conventional fluoroscopic-guided access. The landscape of ultrasound use among contemporary interventional cardiologists is unknown.

Methods: We sought to describe current knowledge, attitudes, and practices regarding ultrasound use among interventional cardiologists using an online survey. The questionnaire unfolded in phases, initially attempting to define current attitudes and then testing whether or not attitudes were adjustable after summarizing compelling research supporting the use of ultrasound-guided access.

Results: Sixty-eight responses were received (60.7%). Only 13.3% reported using ultrasound routinely despite widespread availability and technical expertise. The majority of respondents believed ultrasound use to be slower but safer than access by palpation alone. There was no significant association between age (P=.70) or annual case volume (P=.11) and baseline ultrasound use. After examining the results of a supporting clinical trial, 42.6% said ultrasound should be used routinely, but only 17.6% said they would adopt the technique. Younger operators tended to affirm routine ultrasound adoption after reading the trial summary more often than older respondents, although this did not reach statistical significance (relative risk = 1.8; P=.30).

Conclusions: Routine ultrasound-guided femoral artery access and awareness of its validating evidence is uncommon among current interventional cardiologists; exposure to compelling data had minimal impact on respondents' willingness to change practice.