Wrist Access Safer, Easier for Many Patients Undergoing PCI
January 19, 2009 – The radial access approach to minimally invasive procedures will mean less bleeding, less down time, lower costs and less risk overall, particularly for obese patients, according to data being presented at the 21st annual International Symposium on Endovascular Therapy (ISET) this week near Miami Beach, FL.
Every year, about 1 million Americans opt for angioplasty over bypass surgery to open their blocked arteries. New data suggests that beginning the angioplasty procedure by entering through the wrist - rather than through the groin - will make it safer and easier on patients.
There is a risk of bleeding and nerve damage at the femoral artery access site. To reduce the risk, patients must lie down for two to six hours after treatment. Also, accessing the femoral artery in the groin is particularly challenging and risky in obese people.
Accessing the blocked blood vessels through the wrist (radial) artery, rather than the femoral artery significantly reduces the risk of bleeding and nerve damage, suggests data on more than 5,000 procedures performed at Baptist Cardiac and Vascular Institute, Miami. The radial approach also is easier on patients because they can sit up after the procedure and walk away almost immediately.
Currently, only about 2 percent of all minimally invasive heart treatments are performed through the wrist.
“I believe 75 percent of patients would be candidates for the radial approach if it were an option,” said Ramon Quesada, M.D., medical director of interventional cardiology at Baptist Cardiac and Vascular Institute, and ISET course director. “The radial approach is a bit more technically challenging for physicians, but once they master it, I think most would prefer it. One of the main barriers is a lack of training opportunities.”
When the femoral access approach is used, there is a 2.8 percent risk of bleeding or nerve damage, according to studies. Most patients spend at least one night in the hospital after the procedure. Although rare, the bleeding can lead to kidney failure, blood infection and death. At Baptist Cardiac and Vascular Institute, the complication rates for the radial approach are extremely low; only 0.3 percent had bleeding complications. None suffered nerve damage. An overnight stay may be advisable, depending on the complexity of the intervention performed, not because of the access approach.
The radial approach is not appropriate for all patients, including those who have very small or twisted arteries or are extremely thin, said Dr. Quesada.
“Using the radial approach results in lower cost, less time before the patient can get up and walk around and fewer complications,” said Dr. Quesada. “Patients who are ideal candidates for the radial approach are those who are obese or have severe peripheral arterial disease (PAD).”
For more information: www.ISET.org