Program Justification

Transradial Vascular Access affords the following advantages over transfemoral access:

• Reduced access site complications
• Earlier mobility of patients
• Reduced intensity of post-procedure care
• Reduced length of hospital stay
• Expedited throughput in the cath lab
• Enables outpatient PCI
• Earlier return to productivity for patients
• Reduced cost of vascular closure devices
• Increased comfort for patients

... and with coming changes in CMS guidelines, there will also likely greater revenue for hospitals and physicians that provide a transradial option to their patients.

The results of the RIVAL Trial (A randomized comparison of RadIal Vs. femorAL access for coronary intervention in acute coronary syndromes) were presented at the American College of Cardiology (ACC) 60th Annual Scientific Sessions on April 4, 2011. Among the findings were that patients who undergo diagnoistic or interventional endovascular procedures have similar probability of survival whether their radial or femoral artery is used for access. However, when patients are suffering from an acute coronary syndrom such as an ST elevation myocardial infarction (STEMI), there is significant survival benefit if the coronary arteries are accessed via the radial artery.

RIVAL is the first large North American randomized clinical trial comparing the two artery access options. The findings are likely to increase utilization of transradial access in the United States because:

1. Radial access has now been shown to be a safe and effective technique in patients.
2. ACS patients have a significant survival benefit when they were treated transradially.
3. Radial access is preferred by patients.

Although radial access has been used for some time globally, in many countries being used as much as 20-90% of the time, it remains relatively unused in the United States. Importantly, the RIVAL Trial results showed that physicians with more experience using the transradial technique had the best outcomes. These findings highlights the need to provide high-quality, practical physician and nurse/tech education and training in transradial access to a large number of providers, as currently only ~5% of coronary procedures in the United States are performed transradially.

It is the goal of PAMEAS to have transradial access increase in utilization to 50% of all diagnostic and interventional endovascular procedures in the United States by 2020. To do this we want to provide transradial training to 1,000 interventionalists plus their staff per year.