The Medical Minute: Different approaches to cardiac catheterization

By Ian C. Gilchrist, M.D.

Cardiac catheterization involves threading a thin flexible tube through a blood vessel to the heart. In general, this procedure is done to get information about the heart or its blood vessels, or to provide treatment in certain types of heart conditions, such as angioplasty to open blocked vessels.

In the United States, about 97 percent of cardiac catheterizations are done by inserting the catheter into the femoral artery, a large vessel that pulsates in the groin. Challenging this traditional groin approach is a technique called transradial cardiac catheterization, which uses the radial artery, a small artery at the base of the thumb. While about 3 percent of cardiac catheterization procedures in the United States are done via the wrist, more should be.

While cardiac catheterization procedures have become relatively safe, they still can be improved. Patients usually experience little or no sensation from the cardiac catheterization itself. But the traditional groin approach often leaves patients with discomfort from the pressure applied to the groin area when the catheter is removed. In about 5 percent of these traditional procedures, the groin can bleed or heal poorly. Since the femoral artery is the size of a garden hose, bleeding can be quite rapid and life threatening. In some cases, this requires surgery to repair the artery, and rarely, can result in the death of a patient. It has been reported that heart patients who undergo catheterizations that are complicated with bleeding are much more likely to die than those who do not have a bleeding complication.

Even after the risk of bleeding from the site has passed, patients must remain on bed rest for several hours and may not drive for several days. Groin discomfort or soreness can remain for days.

Less risk in the wrist

The radial artery is a small artery — about the diameter of a straw — in the wrist near the base of the thumb. It is one of several blood vessels feeding the hand. Its small diameter and closeness to the surface of the arm make severe bleeding complications almost unheard of. In addition, the site is held to prevent bleeding with a band around the wrist so the patient can walk immediately after the catheterization procedure, and no bed rest is required. In fact, patients can drive and return to work the next day. Using the wrist approach, cardiologists can perform the same procedures typically done through the groin without the hazard of bleeding and without leaving the patient with a disabling groin injury.

Why so few doctors use the wrist approach

The wrist approach to cardiac catheterization is popular outside the United States, especially in Canada, Western Europe, China and India. American cardiologists have been slow to adopt this technique since few locations offer training and many American cardiologists have stuck to their traditional ways. Penn State Milton S. Hershey Medical Center is one of the leading training centers in the United States for the wrist approach, and faculty have published papers describing its effectiveness. More than 50 percent of cardiac catheterizations performed at the Medical Center are done using the wrist technique.

Using this newer technique drastically reduces the risk of bleeding complications that are, unfortunately, too common during groin-based cardiac procedures. Patients having cardiac procedures, such as stent placement to open a clogged artery, through the wrist often can return home the same day. In addition, patients who have had cardiac catheterizations using both the groin and wrist methods almost universally report less discomfort and a marked preference for the wrist approach.

For more information, please visit Penn State Hershey Heart and Vascular Institute Invasive Cardiology online.

Ian C. Gilchrist is a professor of medicine, Penn State College of Medicine, and an interventional cardiologist within Penn State Hershey Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center.
 

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Last Updated March 19, 2009