Transradial versus Transfemoral Access Route for Elective Endovascular Procedures: A Single-center Cost-analysis Study

Introduction: With this vast array of treatment options for neuroendovascular pathologies, it is imperative to provide the best curative option while minimizing cost. Medical equipment used during endovascular procedures such as catheters, sheaths, and closure devices largely contribute to the overall cost of a patient’s hospital course.The aim of this study was to compare overall procedure cost while shedding light on itemized costs of medical equipment between patients treated electively via the TR and TF routes.

Methods: This is a retrospective single-center study of elective endovascular procedures performed between December 2019 and March 2022 using the TR and TF route.

Results: The study comprised of 318 patients diagnosed/followed-up via the TF route and 615 patients diagnosed/followed-up via the TR route. The rate of a bovine aortic arch was significantly higher in the TR cohort (2.1% vs 0%, p=.009). The mean total hospital cost of patients diagnosed/followed-up via the TR route was comparable to that of the TF route (12854$  18515 vs 13155$ 21607, p=.84). The median cost of catheters was significantly higher in the TR cohort (55.2$ (12.4-369) vs 12.4$ (12.4-1900), p=.03), while the median cost of closure devices was significantly higher in the TF cohort (87$ (87-174) vs 20.2$ (20.2-40.4), p < .001), and the mean cost of sheaths was significantly higher in the TF cohort (44.6$  11.6 vs 41.1$ 3.1, p < .001). The number of sheaths, catheters, guidewires, and closure devices used was comparable between both cohorts.

Conclusion : In recent years, the transradial (TR) approach for neuroendovascular procedures has become more common. In this study, we do not only demonstrate that the cost of TR elective procedures is comparable to TF procedures, but also show that the TR approach is associated with lower costs of closure devices, sheaths and other devices used in emergent complications during these procedures.