Journal of Invasive Cardiology

The radial artery approach to diagnostic cardiac catheterization has emerged as an attractive alternative to the femoral artery approach in recent years, especially in Canada and Europe, due to more familiarity and training.^1,2 In experienced hands, the radial approach has been shown to minimize patient discomfort, achieve early ambulation and discharge,^3,4 with a reduced incidence of bleeding and other vascular complications compared with the femoral approach.^5–8

Cost comparisons have been made between the radial and femoral approaches to diagnostic cardiac catheterization, demonstrating reduced cost with the radial approach.^3,9–11 However, previous studies did not include patients who received femoral puncture closure devices.

Therefore, we sought to determine the cost effectiveness of the radial artery approach to diagnostic cardiac catheterization compared with the femoral artery approach in two groups, one with and one without the utilization of closure devices.

Methods

Patient population. Patients who underwent diagnostic cardiac catheterization between October 2004 and December 2005 at Salem Veterans Affairs Medical Center were identified for cost analysis. Patients were excluded if they required additional adjunct procedures such as coronary intervention, peripheral angiography or intervention, right heart catheterization, cardiac biopsy, intra-aortic balloon pumping or coronary artery bypass graft cannulation.

Catheterization approaches. The femoral approach was performed through the right or left femoral artery based on femoral pulse strength, patient anatomy and operator discretion using 18 gauge, 70 mm long Cook needles (Cook, Inc., Bloomington, Indiana), and 5 or 6 Fr Cordis sheaths (Cordis Corp., Miami, Florida) and Judkins catheters. At the end of the procedure, the femoral sheath was removed and hemostasis was achieved either manually, with a mechanical device, or using a closure device — the Angio-Seal^™ (St. Jude Medical, St. Paul, Minnesota) or Perclose^® (Abbott Vascular, Abbott Park, Illinois).

The radial approach was performed only in patients who had a normal Allen’s test, preferentially through the right radial artery. Access into the radial artery was achieved using a 21 gauge, 25 mm long Cook needle. This was followed by the introduction of a 5 Fr Cook Flexor Check-Flo Performer Introducer set with hydrophilic coating. Then a “cocktail” of nitroglycerin (50 mcg), heparin (2,000 U), lidocaine 1% (10 mg), verapamil (1.25 mg) and 0.9% normal saline (3.5 cc) was injected intra-arterially through the radial introducer. A 5 Fr multipurpose MPA 2 Cordis catheter was the initial choice in all patients. At the end of the procedure, hemostasis was achieved with manual compression and a D-Stat Radial band (Vascular Solutions, Inc., Minneapolis, Minnesota).

Our catheterization laboratory policies for recovery times were concordant with the 2001 ACC/SCAI Catheterization Standards recovery times of 2–6 hours for the femoral approach and 1–2 hours for the radial approach. All femoral and radial procedures were performed by the same operator.