At Memorial Hermann Heart and Vascular Institute – Texas Medical Center, we have expanded our already robust cardiac care offering to include radial approaches for interventional procedures. Memorial Hermann is one of the largest providers of cardiovascular care, performing thousands of interventional procedures annually in the cath lab. Offering radial approaches for interventional procedures has elevated Memorial Hermann’s level of patient care, by making interventions safer for patients by limiting complications.
Radial access is growing in popularity and prevalence globally. Most U.S. students are taught percutenous coronary intervention (PCI) using the femoral artery, an artery accessed through the patient’s groin, which offers a wide pathway to the heart. However, in many European countries (such as France, Italy and Spain), radial access through a patient’s wrist is not only common, but is becoming the preferred route, and not just when femoral arterial disease and obesity hinder vascular access.
Radial interventions are being driven by factors including lower risk of complications, lower direct costs, reduced recovery time and increased comfort. Research was released at this year’s American College of Cardiology (ACC) Annual Scientific Session and i2 Summit by Sanjit Jolly, M.D., that shows while radial access and femoral access are both safe and effective in reducing overall rates of death, stroke and non-CABG (coronary artery bypass graft) related major bleeding, radial access reduced major complications compared with femoral access, with similar PCI success rates.
Research also shows radial intervention significantly reduces bleeding complications during angioplasty and stenting, cutting by nearly 60 percent the risk of bleeding complications following PCI, while maintaining a high procedural success rate. Radial access can also be much safer for bariatric patients who are at high risk of serious bleeding with femoral intervention when complications occur.
Besides being safer for the patient, radial access is also more comfortable. After radial intervention, patients experience rapid ambulation. The lower risk of complications, coupled with faster ambulation, results in speedier recovery, better patient comfort and reduced length of stay. By reducing complications and improving recovery time, patients are discharged from the hospital faster, which helps lower overall healthcare costs.
Implementing the Radial Approach
As advancements in vascular X-ray technology are made to support radial access, more interventional cardiologists can be educated, trained and gain experience to become experts in these procedures. One of the challenges with radial access is a significant learning curve, as it requires a higher level of proficiency and requires the entire interventional team to adopt a new skill set. The radial artery, which is accessed near the patient’s wrist, is smaller than the femoral artery. Using the radial approach requires specialized technical skills to successfully navigate the precarious pathway up the patient’s arm and shoulder to access the heart.
To help facilitate more radial procedures, we installed five Toshiba America Medical Systems Infinix-i systems, each featuring a five-axis C-arm that enables head-to-toe and fingertip-to-fingertip coverage. This allows greater access to the patient from the right or left side. For the most common approach – right-arm access – the C-arm can be positioned to provide access to the right arm of the patient, with the ability to maneuver over the heart and down to the wrist. When working a case from the left radial approach, the system offers the same unparalleled patient access and movement on the left side. The design of the system allows flexible positioning of the monitors and of the C-arm without having to pivot the table to reposition the patient. This way we can work easily from either side of the table. This creates an ergonomically comfortable environment for the interventional team and the patient, regardless of catheter entry point.
Our interventional team’s learning was also enhanced by the system’s ability to locate the tableside controls, footswitch and table panning functions on the same side of the table as the radial entry, which aids catheter handling and overall ergonomic convenience. The monitors can be moved in front of the team on either side of the patient or positioned closer for easy viewing. Most important, the system’s design offers the additional option to switch from radial to femoral during procedures, if required, with minimal disruption to the interventional team and the patient.
After a nine-month period of bringing our team at Memorial Hermann Heart and Vascular Institute – Texas Medical Center up to speed on radial intervention, we have had great success and perform between 200–300 radial cases annually. With the Infinix-i systems, we are using the radial approach in 80 percent of the interventional cases we handle. Our goal as an organization is to use the radial approach whenever it is viable for the patient, as it has a lower risk of complications, is more comfortable for the patient, offers a faster recovery time and will ultimately help lower healthcare costs.
Editor’s note: Colin Barker, M.D., is a cardiologist at Memorial Hermann Heart and Vascular Institute – Texas Medical Center and an assistant professor at University of Texas Health Science Center at Houston (UTHealth). Barker performs the radial approach in 80 percent of the interventional cases he handles.
1. “Randomized Comparison of Radial Versus Femoral Access for Coronary,” by Sanjit Jolly, M.D., Presentation at the American College of Cardiology (ACC) meeting, April 2011.
2. Cath Lab Digest article, Source: Journal of the American College of Cardiology (JACC) Cardiovascular Interventions, August 2008