Known as transradial catheterization, the procedure involves inserting a thin plastic tube into an artery in the wrist, instead of into an artery in the groin (femoral catheterization), which is the more conventional approach. In either approach, longer tubes called catheters are then placed into the heart arteries, and dye is injected to look for blockages and treat them with stents, if needed.
Access through the wrist typically results in a quicker recovery time for the patient, generally causes less discomfort and has less bleeding risk compared to using the groin. Patients are able to sit up immediately after the procedure, which allows the patient to avoid the several hours of flat bed-rest that would be needed after a femoral procedure.
“After catheterization through the groin, manual pressure is applied for 15 minutes on the groin access site to help seal the blood vessel. Then, the patient typically has to lie flat for several hours to make sure there is no bleeding from the site. The risk for bleeding is overall low, but can be quite serious if it happens,” said Elaine Demetroulis, M.D., an interventional cardiologist with the UI Heart and Vascular Center. “There are times where special devices can be used to limit the bed-rest time in groin-access procedures, but these are not always usable and do not improve any of the complication rates compared to holding manual pressure.
“In contrast, when we use the wrist to perform the procedure, patients can sit up immediately after the procedure, and a simple band around the wrist can be used to keep pressure on the artery. It’s more convenient and comfortable for the patient, and there is far less risk of potentially serious bleeding complications,” Demetroulis added.
The wrist-based procedure can also be used for, and is actually preferable, in patients who are on blood thinners. In addition, it can be used for patients who have difficulty resting on their backs for long periods of time because of back pain or other types of pain. Although most people needing a cardiac catheterization would be candidates for the wrist-access approach, Demetroulis noted that actual use is based on considering each patient individually.
One patient who benefited recently from transradial catheterization is Robert Rhoads, 67, of Muscatine. The retired materials manager first had a heart attack in 1990 and since then has undergone a quadruple bypass and several other heart-related procedures at UI Hospitals and Clinics.
In late February, Rhoads had two stents put in to open up blockages to arteries in his heart using groin access but needed to return for another procedure. At that time, UI Heart and Vascular Center experts decided to use the wrist-access approach to place a stent in his heart artery.
With just a tiny red mark on his wrist as a reminder of the recent procedure, Rhoads is back at home following up on his cardiac rehabilitation plan.
“The only time I felt anything was when they were putting the tube into my wrist at the very beginning,” Rhoads said. “The wrist method is easier on your body than the traditional method, and you recover much quicker. My hospital stay was about half of what it previously was.”
The shorter recovery times after the procedure, reduction in bleeding complications, and potentially shorter hospital stays are benefits that should also help reduce overall costs in the health care system. But as Rhoads’ experience suggests, patients are already counting on the patient-specific advantages of the wrist-access procedure.
“Although the radial procedure requires the doctor to make the catheter follow a thinner and sometimes more circuitous path, the procedure is generally overall more comfortable and results in fewer bleeding complications for patients,” Demetroulis said.
Transradial cardiac catheterization was first performed experimentally in the 1960s but was not used more widely until the 1990s, primarily in Europe and other areas outside the United States.
“Using the wrist to perform this procedure is still less common than using the groin currently in the United States, but the wrist approach is definitely gaining favor because of some of the unique benefits of this approach,” Demetroulis said.
To learn more about transradial catheterization at the UI Heart and Vascular Center, call UI Health Access at 319-384-8442 or 800-777-8442.
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