Health Economic Analysis of Access Site Practice in England During Changes in Practice

Mamas, Mamas A.; Tosh, Jonathan; Hulme, William; Hoskins, Nicki; Bungey, George; Ludman, Peter; Belder, Mark de; Kwok, Chun Shing; Verin, Nathalie; Kinnaird, Tim; Bennett, Ewan; Curzen, Nick; Nolan, James; Kontopantelis, Evangelos

doi:10.1161/circoutcomes.117.004482

Cited by 47 publications

(41 citation statements)

References 22 publications

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“…The transradial approach (TRA) has been widely adopted for coronary, peripheral, and cerebrovascular endovascular procedures due to the overwhelming evidence demonstrating a reduction in access site complications, in addition to improved patient preference and cost compared with traditional transfemoral access (TFA) 1–9. Led by the interventional cardiology community, large randomized multicenter trials such as the Radial versus Femoral Access for Coronary Angiography and Intervention in Patients with Acute Coronary Syndrome (RIVAL) and Minimizing Adverse Haemorrhagic Events by Transradial Access Site and the Systemic Implementation of AngioX (MATRIX) studies, with over 7000 patients each, have reported a greater than 60% reduction in vascular complications as well as significant decreases in all-cause mortality and net adverse clinical events with TRA 10 11.…”

Section: Introductionmentioning

confidence: 99%

Transradial access for neurointerventions: management of access challenges and complications

Brunet

Chen

Peterson

2019

J NeuroIntervent Surg

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BackgroundNumerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.MethodA careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.ResultsA stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.ConclusionThe ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.

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Section: Introductionmentioning

confidence: 99%

Transradial access for neurointerventions: management of access challenges and complications

Brunet

Chen

Peterson

2019

J NeuroIntervent Surg

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“…The radial artery approach has become an increasingly popular alternative for arterial access in endovascular interventions 1. First described by Campeau2 nearly three decades ago, the use of a percutaneous radial artery approach for angiography has seen a significant increase in the field of interventional cardiology owing to comparative data demonstrating superiority in clinical outcome, patient satisfaction, and cost reduction compared with the standard femoral artery access 2–11. The association between radial access and reduced post-procedural bleeding, major vascular complications, overall adverse clinical events, and hospital length of stay is well documented in the cardiology literature 12–15.…”

Section: Introductionmentioning

confidence: 99%

Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment

Catapano

Fredrickson

Fujii

et al. 2019

J NeuroIntervent Surg

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BackgroundThe transradial artery (TRA) approach for neuroendovascular procedures continues to gain popularity, but neurointerventionalists still lag behind interventional cardiologists in the adoption of a TRA-first approach. This study compares the complications and efficiency of the TRA approach to the standard transfemoral artery (TFA) approach at our institution during our initial phase of adopting a TRA-first approach.MethodsA retrospective analysis was performed on all consecutive neuroangiographic procedures performed at a large cerebrovascular center from October 1, 2018 to June 30, 2019. The standard TFA approach was compared with TRA access, with the primary outcome of complications analyzed via a propensity-adjusted analysis.ResultsA total of 1050 consecutive procedures were performed on 877 patients during this 9-month period; 206 (20%) procedures were performed via TRA and 844 (80%) via TFA. The overall complication rate was significantly higher with the TFA procedures than with the TRA procedures (7% (60/844) vs 2% (4/206), respectively; p=0.003). A propensity-adjusted analysis showed that the TFA approach was a significant risk factor for a complication (OR 3.6, 95% CI 1.3 to 10.2, p=0.01). However, the propensity analysis showed that fluoroscopy times were on average 4 min less for TFA procedures than for TRA procedures (p=0.003).ConclusionThe TRA approach for neuroendovascular procedures appears to be safer than the TFA approach. Although a steep learning curve is initially encountered when adopting the TRA approach, the transition to a TRA-first practice can be performed safely for neurointerventional procedures and may reduce complications.

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“…Radial access for coronary and peripheral interventional angiography has dramatically increased worldwide since its introduction in 1989 by Campeau. Interventional cardiology studies comparing a transradial approach (TRA) with a transfemoral approach (TFA) have shown an unequivocal benefit of the former, with reduced morbidity and mortality, greater patient preference, and cost reductions [14]. Performing the endovascular interventions via forearm radial artery (FRA) is considered preferable due to the lower risk of access site bleeding his is caused by anatomical proximity of the radial artery to the "bone basement" [15].…”

Section: Discussionmentioning

confidence: 99%

Transradial Approach versus Anatomical Snuff Box Distal Radial Access for Coronary Procedures

Montaser¹,

Emara²,

Eletriby³

et al. 2020

WJCD

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Background: Radial artery catheterization is a fundamental approach that is used as a procedural access in the different catheterization laboratories so our study is a comparison between distal radial artery approach and convential traditional transradial approach to explore the fesibility and safety of coronary angiography and percutanous coronary. Aim of the Work: The purpose of our study is a comparison between the conventional transradial approach versus distal transradial approach for diagnostic and interventional coronary procedures. Materials and Methods: This is a prospective study that included 60 patients who presented to the Cardiology departments in Ahmed Maher Teaching Hospital from December 2018 until October 2019 to perform planned Transradial Coronary Angiography and/or coronary intervention. The study is divided into two groups, group (A) included 30 patients who undergone the procedure through the distal radial approach (The Anatomical Snuffbox) and group (B) included 30 patients who undergone the procedure through the traditional Transradial approach. Results: Thrombosis and hospital stay are higher significant in radial group than distal radial group and patient satisfaction is higher significant in distal radial group than traditional Transradial while there is no significant difference between both groups as regard Success and failure rate of cannulation, bleeding, infection and duration of the procedure. Conclusion: coronary procedures by distal radial approach have minor access complication versus the conventional Transradial approach.

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Health Economic Analysis of Access Site Practice in England During Changes in Practice

Abstract: The transition to TRA in England has been associated with significant cost savings across the national healthcare system, in addition to the well-established clinical benefits.

Cited by 47 publications

References 22 publications

Transradial access for neurointerventions: management of access challenges and complications

Transradial access for neurointerventions: management of access challenges and complications

Complications of femoral versus radial access in neuroendovascular procedures with propensity adjustment

Transradial Approach versus Anatomical Snuff Box Distal Radial Access for Coronary Procedures

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