Vascular access in cath lab, costs and complications

Abstract

BG: Radial artery approach (RAA) for diagnostic angiography and intervention is considered the preferred access site, however little is known about the costs of radial or femoral artery approach (FAA). We compared the two strategies in terms of cost effectiveness, hospital stay and post-operative complication in a regional New Zealand secondary care centre. Method: Analysis of 200 consecutive patients undergoing elective and acute diagnostic cardiac catheterisation was studied. Patients awaiting transfer to tertiary centres were excluded from the analysis of the hospital stay variable. Equipment and procedural data was retrospectively analysed for all cases. Results: Intra-operative cost was $141for RAA vs. $150 for FAA (RR 1%, P 0.91). 63% of patients undergoing a RAA stayed < 1 day versus only 35% of FAA stayed < 1 day (P 0.003). The mean length of stay for a RAA was 0.54 days vs. FAA 1.2 days. In elective patients RAA mean length of stay < 0.2 days, vs. FAA 0.7 days (p<0.001). Mean contrast volume in RAA was 100 ml vs 120ml with FAA (P 0.002). Fluoroscopy times were 4mins for FFA vs. 5mins for RAA (p=0.8). No patients undergoing RAA experienced a procedure related complication vs. 3/100 FAA patients had major bleeding complications. Conclusion: Radial approach is cost effective and safer than femoral in a real world secondary care regional PCI centre. These results are consistent with the international trials.