In the United States, more than 1.1 million cardiac catheterizations, also known as heart caths, are performed each year. The medical procedure is used to diagnose and treat some heart conditions, such as diagnosing and clearing blocked arteries in the heart using stents or angioplasty, a technique that widens narrowed or obstructed arteries.
Traditionally, heart catheterization involves the insertion of a long, thin flexible tube (called a catheter) near the groin into a large artery at the top of the leg. The catheter is threaded into the heart or peripheral arteries.
In recent years, a new technique has been gaining momentum and has been shown to reduce potential complications and improve patient outcomes. Instead of accessing the heart through the artery near the groin, the majority of heart cath procedures can now be performed using transradial artery access, which involves inserting a smaller catheter through the wrist.
This approach has many benefits to the patient, including reduced patient discomfort, less time in the hospital and a reduction in potentially life-threatening complications.
One major risk that is reduced through the transradial approach is serious internal bleeding. During the groin approach, internal bleeding may not be detected for one to two hours. The patient then has to be rushed to cat scan to confirm bleeding, and surgery and/or blood transfusion may be required to correct the problem. And in overweight patients, the blood vessel may be deeper in the groin, making it more difficult to identify bleeding at the site. With the approach through the wrist, the chances of bleeding are much smaller, and the bleeding can usually be visibly seen and corrected quickly.
Another significant benefit is that patients can go home more quickly and are permitted to stand up and walk shortly after leaving the cath lab. In contrast, those who receive a heart cath through the traditional method are required to lie on their backs for six to eight hours after the procedure.
Occasionally, a patient may feel burning or discomfort in the arm, but that goes away in a few hours or a day. The majority of patients treated with transradial access have no complications as a result of the procedure, and most don't experience scarring.
The transradial access is an option for almost any patient who needs a heart cath, and is endorsed by the American College of Cardiology. The biggest factor driving the decision to use a transradial approach is the physician performing the procedure, which can be more challenging technically.
Many physicians who are more comfortable with the groin approach will recommend it alone. But a growing number of physicians prefer to the radial artery as their default approach.
There are also many physicians who use the radial approach in situations in which the groin approach may be more complicated, such as in obese patients or patients with obstructions in the blood vessels supplying the leg.
The traditional groin approach may also be selected if preservation of the radial artery is essential, such as patients requiring dialysis fistulas or patients who require the radial artery to be used for bypass surgery.
Dr. Mubashir Qazi is with Kentucky Cardiology at Saint Joseph East, part of KentuckyOne Health.