Radial versus Femoral Vascular Access Options in Coronary Angiography and Intervention

Purpose: The trans-femoral access (TFA) is the universal default to reach the coronary arteries. However there is an increasing interest in trans-radial access (TRA) as it has advantages such as earlier patient ambulation. The objective is to determine patient preferences over benefits, risks and process characteristics of vascular access sites in angiography and/or percutaneous coronary intervention.

Methods: A Best-Worst Scaling (BWS) case 2 was conducted to elicit patient preferences for six attributes of care: length of hospital stay, peri-procedural changing of access-site, suitability of the vessel for next procedure, post-procedural patient comfort, peri-/post-procedural bleeding, and post-procedural mobilization. Patients indicated which aspects they perceived as the best and the worst in eight hypothetical treatment alternatives. In addition, overall preference for TRA/TFA was measured in a direct question format displaying all characteristics. To safeguard the current process, patients were asked to fill out the questionnaire after the invasive procedure was performed. Patients were provided with an (oral) explanation by a researcher. Best-minus-Worst scores, conditional logit analysis, attribute importance, and subgroup analysis were calculated and/or executed.

Results: 143 out of 153 patients completed the questionnaire without response errors. Patients considered the peri-/post-procedural bleeding as most important procedural characteristic (attribute importance 31%), followed by length of hospital stay (23%) and post-procedural mobilization (20%). Peri-procedural changing access-site (18%), suitability vessel for next procedure (8%) and post-procedural patient comfort (0%) were the least important attributes. The highest positively valued level was “the procedure takes place in day-care” and the most negatively valued level was “major bleeding followed by blood transfusion”. Fifty-nine percent of all patients were in favor of the femoral approach when this was directly asked, whereas patients who experienced both vascular routes were in favor of the radial approach (N=36;72%).

Conclusion: As an advantage of the radial access route, shorter post-procedural mobilization was assigned a high positive value and high attribute importance in the BWS exercise. In contrast to post-procedural patient comfort, where patients indicated no preference for either “being limited in daily activities for 24 hours” or “till 3-4 days after surgery only perform light activities”. Patients were able to trade-off characteristics in a BWS exercise and acknowledged an advantages of the radial access route. However, using the direct question, only patients who experienced both access routes were in favor the radial approach. The time of questioning has probably influenced our results, 85% preferred the recently experienced access route. The use of BWS may enhance the discussion on the capability and desirability of shared decision making in the cardiology department, especially in decisions where there is no preference from clinical point of view.