October 3, 2013 — While 95 percent of cardiac catheterizations in the United States are done through the groin, physicians at Bethesda Heart Hospital are utilizing special training to offer patients a safer, more comfortable procedure.
Transradial artery catheterization is a less invasive endovascular technique that gives physicians access to the heart through the patient’s wrist rather than through the femoral artery in the groin. Using slightly smaller equipment through the radial artery, physicians can accomplish the same goals with fewer complications and a more satisfying patient experience.
“Patients who have had catheterizations done both ways were impressed by the comfort and ease of the radial approach,” said Michael Metzger, M.D. and interventional cardiologist. “A patient can get up from the table. They’re not spending hours lying down with compression on the groin as is required with the femoral approach.”
The femoral approach carries small but significant risks of complications, such as heavy bleeding, arterial damage, bruising or other problems. The transradial method is steadily gaining momentum because it all but eliminates these complications. Jay Midwall, M.D., interventional cardiologist, believes that in the next 10 years, between 30 and 40 percent of all cardiac catheterizations are likely to be done through the radial artery.
“It takes more time, skill and special training,” explained Midwall, adding that the radial procedure is currently prevalent in Europe and the Middle East. “As doctors in the U.S. adopted this technique, two things happened: one, patients preferred it and two, a number of studies showed it was safer with less bleeding.”
Blood flow isn’t compromised during transradial artery catheterization. Anatomical differences or medical conditions occasionally eliminate certain patients as candidates for the radial approach, but most can easily opt for this method. Regardless, both sites are prepped before a procedure begins to offer cardiologists options in case the femoral approach is needed, which is rare, according to Anil Verma, M.D. and interventional cardiologist.
The radial technique reduces the risk of bleeding and damage to blood vessels, and patients are able to stand up and walk more quickly following the procedure. These factors combine to help minimize the length of a patient’s hospital stay and to reduce costs, physicians said.
“If we have complex procedures... that require large catheters, then we have to go through the femoral artery,” Verma said, adding that these include aortic valve implant and intra-aortic balloon pumps. “But in the last 10 years, radial has caught on more and more.”
Support for the radial approach at Bethesda Heart Hospital was early and enduring, noted Metzger.
“When I chose to do transradial catheterizations four years ago, the implementation had a significant learning curve for the team,” he adds. “Now, with 40 percent of Bethesda’s procedures being performed transradially, the staff enthusiastically supports this new approach, recognizing the long-term benefits to our patients.”
For more information: www.bethesdaheart.org