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The Costs & Benefits of Radial Catheterization

The Costs & Benefits of Radial Catheterization

Most patients in the United States undergo femoral artery access for cardiac catheterization procedures despite research demonstrating that radial access can reduce vascular complications and increase patients’ ability to become mobile more quickly after their procedure. It has been speculated that lower adoption of radial artery access could be the result of concerns about increases in procedure time, radiation exposure, and access failure for patients who undergo this procedure. Support for Radial Access for Cardiac Catheterization In Circulation: Cardiovascular Quality and Outcomes, my colleagues and I published a cost-benefit analysis of cardiac catheterization approaches based on results from a systematic review of published randomized controlled trials (RCTs). The analysis combined find­ings from 14 published RCTs, comparing outcomes from coronary angiograms and stenting procedures that were performed via the radial artery versus the femoral artery. These combined findings were inserted into a cost-benefit simulation model that estimated the average cost of care for patients receiving these procedures. The model took into account procedure and hemostasis time, the costs of repeating cath­eterization at alternate sites if a first catheterization failed, and inpatient hospital costs associated with complications from the procedure. We found that radial catheterization significantly lowered the risk for major complications (odds ratio [OR], 0.32), major bleeding (OR, 0.39), and hematoma (OR, 0.36), when compared with femoral catheterization. Regarding procedure time, the radial approach took only 1.4 minutes longer than the femoral approach and reduced hemostasis time by approximately 13.0 minutes, on average. Radial cath­eterization increased the potential for catheterization failure (OR, 4.92), but there were no differences in procedure success rates or major adverse cardiovas­cular events. Potential Cost Savings...
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