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 of a Radial Approach
Using base-case estimates from meta-analysis results, the radial approach cost $275 less per patient from the hospital perspective than the femoral approach. Radial catheterization was favored over femoral catheterization under all conditions tested in the stochastic simulation model of per-case costs. In fact, none of the changes to cost variables brought the net cost savings to a point that would favor femoral catheterization.
Although the radial technique would be associated with a longer learning curve for many cardiologists when compared with the femoral technique, widespread adoption of radial catheterization could result in substantial savings for the healthcare system, considering the vast number of these procedures performed annually. The savings from lowering vascular complications appear to outweigh the increased costs of longer procedure times and access failure. Importantly, continued efforts are needed to determine the ideal candidates for radial catheterizations. Identifying such candidates prior to radial catheterization may further reduce failure rates in these procedures.
Readings & Resources (click to view)
Mitchell MD, Hong JA, Lee BY, et al. Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention. Circ Cardiovasc Qual Outcomes. 2012;5:454-462. Available at: http://circoutcomes.ahajournals.org/content/5/4/454.abstract.
Roussanov O, Wilson SJ, Henley K, et al. Cost-effectiveness of the radial versus femoral artery approach to diagnostic cardiac catheterization. J Invasive Cardiol. 2007;19:349-353.
Kiemeneij F. Cost-effectiveness of transradial coronary access. J Invasive Cardiol. 2007;19:354.
Caputo RP. Transradial arterial access: economic considerations. J Invasive Cardiol. 2009;21(Suppl A):18A-20A.
Elgharib NZ, Shah UH, Coppola JT. Transradial cardiac catheterization and percutaneous coronary intervention: a review. Coron Artery Dis. 2009;20:487-493.