Radial Catheterization Improves Outcomes
Dr. Robert J. Applegate describes the radial approach to cardiac catheterization and its benefit to patients.
From your wrist to your heart: a new cardiac catheterization option
Millions of cardiac catheterization procedures have been performed since the technique was first used to detect blockages in the heart in the 1950s. At the time, the idea of threading a thin tube through a patient’s artery toward the heart, using the body’s circulatory system to clear blockages, deliver medication, and position stents was revolutionary.
For decades, the most commonly used entry point to the circulatory system for catheter-based procedures has been the femoral artery in the groin, but Wake Forest Baptist Medical Center and about 10 percent of medical centers throughout the country have switched to a new access point, the radial artery, located in the wrist. This innovative cardiac catheterization technique reduces recovery time and bleeding and may provide a less stressful option for patients who need the procedure.
What is cardiac catheterization?
Cardiac catheterization is a method doctors use to perform many tests and procedures to diagnose and treat coronary artery disease. The method involves threading a long, thin tube (called a catheter) through an artery (traditionally the femoral artery in the groin) into the heart.
Depending on your condition, different things may happen during a cardiac cath. For example, you may have an angioplasty in which a balloon-tipped catheter is inserted through an artery and advanced through the circulatory system until it reaches the blocked artery of the heart. There the balloon is inflated, flattening the plaque against the artery wall, allowing blood to flow more easily. You may also have a stent placed in the artery. A stent is a mesh-like metal device that acts as a scaffold inside a vessel.
Interventional cardiologists are performing more and more specialized catheter-based procedures to treat a wider variety of heart and vascular diseases.
Why are physicians switching from the femoral artery to the radial artery?
The femoral artery has been used more frequently because its large size can accommodate balloons, stents and almost any size catheter. However, the femoral artery can be difficult to access especially in overweight individuals. Stopping bleeding once the procedure has been completed requires heavy pressure at the needle insertion site, and patients need to remain in the hospital lying quietly on their backs for as long as six hours to ensure there is no bleeding. This can be difficult and painful for some patients, particularly elderly patients and those with hip or back pain. In some cases, there can be internal bleeding that is not immediately visible.
The radial artery in the wrist is close to the skin surface, making the needle puncture more straightforward for the cardiologist and less uncomfortable for the patient. When the procedure has been completed, a band similar to a wristwatch is placed around the wrist, which supplies pressure and prevents bleeding. Most patients are able to get up almost immediately and walk. Unlike the femoral, any bleeding from the radial artery is readily apparent.
Patients who undergo this newer technique have less bruising and bleeding, fewer complications and a faster recovery overall.
Why wasn’t the radial approach used earlier?
It was used in the 1990s for some diagnostic catheterizations, but the early equipment used for balloon angioplasties and stents was too large to use in the smaller radial artery. The development of smaller, easier to manipulate, better-designed catheters and stents has now made the radial approach possible for most catheter-based procedures.
Can the wrist artery approach be used on all patients and for all procedures?
While most people needing a cardiac catheterization would be candidates for the wrist-access approach, each patient must be evaluated individually to determine the most appropriate strategy.
There are two arteries that supply blood to the hand, and it’s important that both are functioning well before undergoing a cardiac cath via the wrist. Doctors do a simple test, called an Allen test, which can be performed in the office, to determine if both arteries are functioning well. If not, the femoral approach may be the safer alternative.
Also, complicated stentings or technologically difficult procedures such as aortic valvuloplasties (heart valve repairs) are best done through the femoral artery.
Is the wrist approach safe?
Yes. Major studies have shown that the radial artery is as successful as the femoral artery approach and has lower rates of bleeding and other complications.
The challenge is the artery near the wrist is roughly half the size of its counterpart in the groin, so increased precision and state-of-the-art technology are required to perform the procedure. The radial approach is more challenging for the physician to learn, and not as many interventional cardiologists in the U.S. have been trained in the technique as in some other countries. Those who have learned the technique tend to use it for most of their patients.
All interventional cardiologists at Wake Forest Baptist Medical Center are experienced practitioners of the radial approach and have switched to the wrist as their access of first choice for appropriate patients. Nearly 1,000 of our patients have been treated using this new technique with great success.
Having this innovative technique available in addition to the traditional approach to catheterization is part of the WFBMC Heart Center’s commitment to offer the most advanced treatments to their patients.