Cardiologists Repair the Heart Through the Wrist

A new approach to common cardiac procedures called transradial angiography might lead to reduced patient complications and recovery time and decreased hospital costs.

Cardiologists at the University of Illinois and Jesse Brown VA medical centers are among the first in the Chicago area to offer the approach to heart angiograms and clearing blocked arteries.

In the procedure, a catheter is threaded through the small radial artery in the wrist rather than the larger femoral artery in the groin.

"It's a simple change that has a dramatic impact on the experience and recovery of the patient," says Adhir Shroff, MD, an assistant professor of cardiology at the University of Illinois.

Although complications from standard catheterization through the groin are low, occurring in only 2% to 9% of patients, the transradial approach can reduce bleeding—the most common complication, particularly among women and elders—to under 1%. It also eliminates much of the discomfort associated with the procedure.

Following a standard angiogram and angioplasty through the femoral artery, the patient needs to lie still on his or her back for four to six hours. This can be very uncomfortable for elders with back problems, Shroff says. Walking can be uncomfortable for days.

In contrast, patients who have the procedure done via the wrist can immediately sit up, eat, and walk without pain, says Shroff.

The transradial procedure has been widely adopted in Europe, where up to 60% of procedures are now done this way. In the United States, only about 2% of coronary interventions use the procedure.

"The issue is really just the learning-curve," says Shroff. "The change requires dozens of small changes—everything from redesigning the sterile drape so that the openings are at the wrist rather than the leg and finding smaller needles, wires and catheters to the way the table is set up."

In addition to offering a ready-made approach to the technique, Shroff said the key is enlisting the help and cooperation of everyone involved in the cath lab, from nurses and nurse-managers to the technicians who set up the equipment.

Schroff says there is no downside to using the transradial approach where appropriate. "And in these times, as everyone tries to think strategically about the delivery of healthcare, the savings in terms of costs and hospital resources offered by transradial catheterization make it especially attractive," he says. "It is my belief that once a patient has their procedure done from the wrist, they will demand that approach in the future, if they require it again."

— Source: University of Illinois at Chicago