Dr. James Wilson, cardiologist, Texas Heart Institute at St. Luke's Episcopal Hospital, explains the benefits of radial artery access for heart catheterization.
By Ronda Wendler, Texas Medical Center News
, October 1, 2010
Used with permission.
IT'S ALL IN THE WRIST—At a follow-up medical appointment, Mike Cahn, right, is greeted by Dr. James Wilson. (Photo by Jamie Farquhar)
The day before Mike Cahn underwent surgery to replace a defective valve in his heart, doctors performed a cardiac catheterization to explore Cahn's internal heart anatomy in preparation for the surgery.
The ease of the method they used to carry out the catheterization left their patient pleasantly surprised. Performed at St. Luke's Episcopal Hospital, the innovative technique uses a small hole in the patient's wrist to access blood vessels leading to the heart. Traditionally, access is through the groin area.
"I'd had the groin procedure over a dozen years ago, and I was all for trying something easier this time," said Cahn, 60, a former marathon runner who had a genetic abnormality in his aortic valve.
In the wrist-access method, doctors make a small hole in the patient's wrist, then insert a thin plastic catheter through the hole into the wrist's radial artery. They advance the catheter through the body's network of arteries in the arm and into the chest until it eventually reaches the heart. Using X-rays to follow the progression of the catheter, doctors can see any abnormalities or problems along the way as the catheter journeys forward. Having this "lay of the land" before surgery helps doctors plan in advance what moves they will make during the patient's upcoming operation.
"Inserting the catheter through the radial artery in the wrist, rather than through the groin, is a great advancement," said James Wilson, M.D., Cahn's physician and the first doctor at St. Luke's to perform wrist catheterization. "The wrist-access approach results in reduced bruising, bleeding and complications compared to groin access. Most patients can sit up and walk immediately after the procedure and have a faster recovery period overall."
Wrist-access catheterization is particularly beneficial for older or obese patients, and for those who have sleep apnea, vascular disease, or poor leg circulation, Wilson said. "It's also excellent for patients with back and spine issues who can't lie on their backs during a procedure," he said.
With groin-access catheterization, doctors make a small slit in the groin area, then insert a catheter through the slit, into the femoral artery in the thigh. They then thread the catheter upward through the body's network of arteries until it reaches the targeted area in the heart. With a catheterization performed through the groin, patients lay flat and immobile for several hours following the procedure, often with pressure applied to the insertion site to prevent bleeding. Some may experience pain and bruising at the site for several days.
Cahn, who was catheterized through the groin in 1998 when doctors cleared a blockage, was amazed at how the wrist catheterization was "such a non-event" compared to groin catheterization. He wore a wrist clamp for several hours after the procedure to prevent bleeding, "but that was the extent of it – the entire experience was amazingly different," he said. "If I ever need a catheterization again," he said, "the hospital staff will have a hard time convincing me to allow the groin procedure."
Though a study by Duke University's Clinical Research Institute shows that wrist catheterization reduces major bleeding anywhere between 58 to 73 percent compared to the groin method, the wrist-access procedure is used in the United States only 1 percent of the time. In Europe, Japan and Canada, it is used 50 percent of the time.
"As physicians become more aware of wrist-access catheterization's benefits, we expect it will really begin to take off," said Wilson.
As for Cahn, he's just been cleared by his doctor to run recreationally, though he'll never compete in marathons again. But that's OK, says the physically fit Cahn, who at 150 pounds weighs 10 pounds less than he did at age 25, thanks to exercise and a carefully controlled diet.
"I'm just glad to be here, living a normal life, as a result of the valve replacement," he said.
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Updated August 2012