Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison

Cooper, Christopher J.; El-Shiekh, Reda A.; Cohen, David J.; Blaesing, Linda; Burket, Mark W.; Basu, Asish R.; Moore, Joseph A.

doi:10.1016/s0002-8703(99)70143-2

Cited by 520 publications

(351 citation statements)

References 13 publications

Supporting

Mentioning

311

Contrasting

Unclassified

Order By: Relevance

“…Despite these recommendations, relatively few economic evaluations have been done for TRI and TFI. Although some studies have suggested cost savings associated with TRI, these studies are relatively small and were conducted mainly in leading centers in the United States 12, 13, 14. Given the differences in health care delivery systems and practice patterns, it remains unclear whether these cost advantages are generalizable to other countries, especially those in the developing world.…”

Section: Introductionmentioning

confidence: 99%

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Jin

Qiao

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundTransradial percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world.Methods and ResultsUsing data from a consecutive cohort of 5306 patients undergoing PCI in China in 2010, we compared total hospital costs and in‐hospital outcomes for transradial intervention (TRI) and transfemoral intervention. Patients receiving TRI (n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo PCI for single‐vessel disease, and less likely to undergo PCI for triple‐vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190 US dollars [$9190]) for TRI and ¥67 418 ($10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method, TRI was associated with a lower total cost (adjusted difference ¥8081 [$1283]). More than 80% of the cost difference was related to lower PCI‐related costs (adjusted difference −¥5162 [−$819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (−¥1399 [−$222]). Patients receiving TRI had shorter length of stay and were less likely to experience major adverse cardiac events or post‐PCI bleeding. These differences were consistent among clinically relevant subgroups with acute myocardial infarction, acute coronary syndrome, and stable angina.ConclusionsAmong patients undergoing PCI, TRI was associated with lower cost and favorable clinical outcomes compared with transfemoral intervention.

show abstract

Section: Introductionmentioning

confidence: 99%

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Jin

Qiao

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery.…”

mentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

167

124

View full text Add to dashboard Cite

T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

show abstract

“…Além do mais, nenhum nervo ou veia expressivos estão no trajeto anatômico do sítio de punção, minimizando os riscos de injúria 3 . A deambulação precoce, permitida pelo acesso radial, produz maior conforto e reduz os custos da hospitalização [4][5][6] . No entanto, o acesso transradial é algumas vezes tecnicamente mais trabalhoso e delicado, demandando maior período de aprendizagem para os operadores [7][8][9] .…”

Section: Discussionunclassified

“…O curso superficial da artéria radial distal e sua proximidade com o osso favorecem a compressão, permitindo aos pacientes rápida movimentação após a retirada do introdutor, melhorando o conforto do paciente. Indivíduos que se submeteram a procedimentos invasivos coronarianos pelas vias clássica ou radial expressam nítida preferência pela última abordagem 5 . Ademais, a possibilidade da realização de intervenção coronariana percutânea ambulatorial pode reduzir os custos e a extensão do período de hospitalização [14][15][16] .…”

Section: Discussionunclassified

Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

Labrunie¹,

Tebet²,

Andrade³

et al. 2009

Rev. Bras. Cardiol. Invasiva

View full text Add to dashboard Cite

RESUMOIntrodução: A via de acesso femoral tem sido a preferida para os procedimentos diagnósticos e terapêuticos coronarianos, mas apresenta limitações, principalmente relacionadas a complicações vasculares e hemorrágicas. O acesso transradial é uma técnica mais recentemente empregada com o objetivo principal de diminuir essas complicações, além de produzir maior conforto e redução dos custos de hospitalização, embora com maior curva de aprendizagem. O objetivo deste estudo foi avaliar a realização de coronariografia transradial, executada por operadores sem experiência na técnica, e comparar com a abordagem clássica (Sones e femoral) em termos de sucesso do procedimento e complicações, analisando a influência da curva de aprendizagem. Método: Estudo multicêntrico realizado em 14 hospitais do interior de São Paulo, no período de um ano. Foram randomizados mil pacientes de maneira equivalente para as técnicas transradial ou clás-sica. Resultados: A taxa de sucesso em ambos os grupos foi similar (97,8% vs. 98,5%; P = 0,47). No grupo clássico, 95,2% dos procedimentos foram realizados pela técnica de Sones. O número de cateteres utilizados, a duração do procedimento e o tempo de exposição aos raios X foram maiores no grupo transradial (P < 0,001). Não houve diferença quanto às complicações maiores (morte, infarto e acidente vascular cerebral) e quanto às complicações vasculares e hemorrágicas. Os grupos que realizaram mais de 100 procedimentos pela artéria radial (3 centros/5 operadores) obtiveram menor taxa de insucesso (1,6% vs. 3,6%; P = 0,04). Conclusão: Um período de aprendizagem para a realização de procedimentos pela via transradial mostra-se necessário, porém não se acompanha de menor índice de sucesso, nem tampouco de maior taxa de complicações para os pacientes. DESCRITORES: Artéria radial. Angiografia coronária. Aprendizagem. ABSTRACT Transradial Coronary Angiography: Learning Curve, Evaluated by a Multicenter StudyBackground: Femoral access for diagnostic and therapeutic coronary procedures has been the dominant approach worldwide, despite an increased risk of vascular and hemorrhagic complications. The transradial approach is a more recent technique used to reduce these complications, providing more comfort and reducing hospitalization costs. However, it is associated with an inherent learning curve. The aim of the study was to evaluate transradial coronary angiography performed by inexperienced operators and compare the success and complication rates of this technique with the classical approach (Sones and femoral), analyzing the influence of the learning curve. Methods: Multicenter, randomized study, in 14 hospitals in São Paulo State in a one-year period. One thousand patients were randomized to the transradial or classical techniques. Results: The success rate was similar in both groups (97.8% vs. 98.5%; P = 0.47). Sones technique was used in 95.2% of the procedures in the classical technique group. The number of catheters used, the duration of the procedure and X-ray exposure were greater in the tr...

show abstract

Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison

Cited by 520 publications

References 13 publications

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Radial Artery Patency After Transradial Catheterization

Coronariografia via transradial: curva de aprendizagem, avaliada por estudo multicêntrico

Contact Info

Product

Resources

About