The many radial access learning curves.

The radial approach to endovascular procedures has a series of learning curves: diagnostic heart catheterization, low-risk settings and "straightforward" percutaneous coronary intervention, high-risk settings, and complex coronary intervention, and peripheral vascular angiography and intervention. For diagnostic and low-risk interventional procedures, incremental improvements in technical success and safety are observed in the initial 200 procedures for most operators compared to highly experienced operators. Formal didactic training and ongoing support/review from an experienced radial operator(s) may expedite surmounting the series of radial learning curves while maintaining optimal procedural success and safety. Advances in technology and understanding will require the most experienced radial operators to continually embrace their next learning curve.