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...

Improving Cardiac Catheterization

More than 1 million cardiac catheterizations are per­formed in the United States annually, and most of these procedures are performed via the femoral arter­ies through the groin. With transfemoral catheterization, patients must lie flat for 4 to 6 hours after the procedure. This is necessary to ensure the puncture site reaches hemostasis and to prevent bleeding complications. Transfemoral cath­eterization can be painful for patients once the procedure is completed because there is a need to compress the artery for 20 minutes manually. The decreased mobility after the proce­dure can also lead to other problems during hospitalization. An alternative approach that is being used by more and more clinicians nationwide is transradial catheterization. In these procedures, the coronary arteries are accessed via the wrist, enabling patients to become mobile almost immediately after the procedure. After the surgery, patients can walk, sit upright, use the bathroom, and eat and drink more quickly than with the transfemoral approach. The transradial approach has also been associated with lower complication rates and increased patient comfort. The complication rate for the transfemoral approach varies but can be as high as 3% to 5%. For transra­dial approaches, the rate drops to less than 1%. In addition, the bleeding associated with transfemoral approaches can be more dangerous than for that of transradial procedures. History of Transradial Catheterization The first transradial diagnostic catheterization was per­formed in the late 1980s in Europe. In 1993, a research team in Amsterdam began using the technique for interventional procedures. In recent years, the methods for catheterization have become increasingly enhanced. Some interventional cardiologists view transradial catheterization as the optimal choice for a...