Friday, July 11, 2014
Inquirer Daily News

Reaching the heart through the wrist is a safer way of catheterization

There is more than one way to the human heart, and U.S. cardiologists are starting to take advantage of that fact.

They are using the patient's wrist rather than the groin to gain access to an artery that leads to the heart - an approach that has been proven to make this common procedure safer and more comfortable for the patient.

Called cardiac catheterization, the procedure is done on about three million Americans a year to diagnose and treat cardiovascular problems such as heart failure, heart attacks, and clogged blood vessels.

In Europe, Canada, South America, and Japan, studies show most cardiac catheterizations are now done through the wrist, using the right or left arm's radial artery to access the heart. In contrast, only about 8 percent of U.S. catheterizations are "transradial" - although that proportion has been growing steadily over the last five years and varies widely, research shows.

At Lankenau Medical Center in Wynnewood, 70 percent of 1,800 catheterizations a year are being done through the wrist, compared with fewer than 10 percent in 2009.

"The big reason to change is that with radial access, there are fewer vascular complications" such as bleeding, bruising, and artery injuries, said Paul M. Coady, an interventional cardiologist at Lankenau.

Traditionally, the catheter - a thin, hollow tube - is threaded through a small incision in the groin into the femoral artery, the circulatory system's superhighway to the heart. A dye visible on X-rays is then injected into the artery to picture the heart's network of blood vessels.

If a vessel is clogged, the cardiologist can widen it, then prop it open with a device called a stent - all done through the catheter under X-ray image guidance.

After the femoral catheter is removed, the patient must lie still and flat in bed for four to six hours to allow a clot to close the incision. Not only is the immobility uncomfortable - especially for people who are obese or have bad backs - but it ties up a hospital bed, takes nursing care, and delays discharge.

Doctors have tried devices such as collagen plugs to hasten femoral-artery closure, but these raise costs and occasionally cause infection or abnormal clotting, said Ronald Fields, an interventional cardiologist who directs the vascular laboratory at St. Mary Medical Center in Langhorne.

After a radial catheterization, in contrast, the patient can sit up almost immediately, move around, and go home after just a few hours of wearing a wristband.

"It's almost unheard of to have serious bleeding with radial access," Fields said.

This week, a major study added evidence that radial access is better, even for patients in the throes of a heart attack or acute chest pain.

The Canadian-led trial of 7,021 such patients at 158 hospitals in 32 countries found that radial and femoral catheterization were equally good for restoring blood flow and had the same rate (3.2 percent) of dire problems - death, heart attack, or stroke.

Only 1.4 percent of radial-access patients had bleeding at the incision, compared with 3.7 percent with femoral access.

Thirty days later, only 42 radial patients had large bruises at the site, compared with more than twice that many with femoral access.

Radial access "was commonly preferred by patients for subsequent procedures," noted the study, published online in the Lancet.

That does not mean radial access is invariably better. About 10 percent of patients are not candidates because of quirks in the anatomy of their radial arteries, studies show.

Radiation is another consideration. Because the arm vessel is narrower and harder to navigate, it takes a bit longer, which "slightly" increases the patient's exposure to X-rays, said Coady at Lankenau.

Alex Malatesta of Collegeville was glad to have the radial option a month ago when, at age 34, he went to Lankenau's emergency room suffering terrible chest pains.

"Dr. Coady explained it was a relatively new procedure, and there would be less bleeding and a quicker recovery," recalled Malatesta, who has heart disease in his family. "He said going through the wrist doesn't always work, but if they could do it, it was preferable."

The procedure showed that a completely blocked cardiac artery had triggered a heart attack. Coady widened the vessel and implanted a stent.

"It was all done within an hour," recalled Malatesta, who was under twilight sedation. "Afterward, they had me sitting up. I wore a wristband for a few hours."

A week later, he was back at his job as a business-to-business salesman, armed with a healthier diet and heart medications.

He also quit smoking.

 


Contact staff writer Marie McCullough at 215-854-2720 or mmccullough@phillynews.com.

Marie McCullough Inquirer Staff Writer
Latest Health Videos
Also on Philly.com:
Stay Connected