title: Transradial versus transfemoral approach in coronary angiography: a matched pair analysis of cath lab equipment costs.
abstract: BACKGROUND
  There is an ongoing struggle to understand the potential economic benefits that radial access may offer. Cost savings are thought to primarily occur after the procedure. The aim of our study was to analyze cath lab expenses resulting from transradial (TRA) and transfemoral approaches (TFA).
  
  
  METHODS
  A total of n = 1890 matched pairs of patients were analyzed. A traditional Judkins catheter strategy was pursued for coronary angiography. Three large databases were merged to collect and compare procedural data as material, medication costs and fluoroscopy time.
  
  
  RESULTS
  Compared to TFA diagnostic catheterization from TRA was associated with significantly lower procedural costs (€181.0 versus €167.5; p&lt;0.001). Extra costs in TFA were primarily produced by frequent use of vascular closure devices (VCDs) in 86% of patients. However, the potential saving amount related to VCD use was only partly realized due to the higher number of extra catheters (0.53 ± 0.9 versus 0.23 ± 0.6; p&lt;0.001) and hydrophilic guidewires (0.088 ± 0.3 versus 0.014 ± 0.1; p&lt;0.001) used in TRA. Weak correlations were observed between the total number of cases and fluoroscopy time (r = -0.13; p&lt;0.001) as well as material costs (r = 0.31; p&lt;0.001).
  
  
  CONCLUSIONS
  Significant cost savings can be realized by TRA at the procedural level even when adhering to a conventional Judkins catheter strategy. Hydrophilic guidewires and additional catheters are the main cost drivers in TRA. In contrast to fluoroscopy time material costs steadily increase during the early stage of the TRA learning curve.
authors.affiliation: 1 Department of Cardiology, Johanniter-Hospital Duisburg Rheinhausen, Duisburg - Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Plehn
authors.forename: Ahmet
authors.initials: A
authors.lastname: Örnek
authors.forename: Georgios
authors.initials: G
authors.lastname: Gkiouras
authors.forename: Julia
authors.initials: J
authors.lastname: Vormbrock
authors.forename: Petra
authors.initials: P
authors.lastname: Maagh
authors.forename: Thomas
authors.initials: T
authors.lastname: Butz
authors.forename: Axel
authors.initials: A
authors.lastname: Meissner
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D062906:Cardiac Catheters / Q000191:economics; D002406:Catheterization, Peripheral / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D017023:Coronary Angiography / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery; D017721:Hospital Costs; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011237:Predictive Value of Tests; D017534:Radial Artery; D012189:Retrospective Studies; D062666:Vascular Access Devices / Q000191:economics