Transradial Cardiac Catheterization
The Way To Go
When Angelo Biagetti, 69, of Milford, was told he needed to undergo a cardiac catheterization—a procedure that allows physicians to examine the arteries that supply the heart muscle—he was anxious. However, he knew the procedure was necessary to identify the cause of his ongoing chest pain.
This wasn’t Angelo’s first catheterization. He had a femoral catheterization 10 years earlier during which a cardiologist inserted a thin, hollow, flexible tube called a catheter through the femoral artery in his groin and into his heart. The procedure left him badly bruised from his waist down to his knee. “It scared me,” recalls Angelo. “It was scary to see my entire body on one side all black and blue.”
Angelo also recollects having to endure a lot of painful pressure over his femoral artery following the procedure as staff worked to seal the artery. He was then required to lay still and flat on his back for six hours before going home. He wasn’t looking forward to this experience again.
Fortunately, this time would be different. William Shine, MD, FACC, of Hopedale Cardiology and director of the cardiac catheterization lab at Milford Regional, explained to Angelo that he might be a candidate for transradial artery catheterization – a new technique during which a catheter is inserted through the radial artery in the wrist instead of the femoral artery. Cardiologists at Milford Regional began performing transradial catheterizations in March 2011. Currently, 75%-85% of patients who need a catheterization are eligible for the transradial approach.
According to Dr. Shine, though the quality of images produced by a femoral or transradial catheterization is identical, the benefits of using the radial artery far outweigh the femoral site. First, though femoral artery catheterizations are extremely safe, access through the radial artery has even less risk.
Second, it’s much easier and safer to seal the radial artery after the procedure is over. The femoral artery is approximately the size of a thumb and located deep within the groin, while the radial artery is typically smaller than a pencil and close to the surface of the skin, explains Dr. Shine. Closing the femoral artery requires 20-30 minutes of firm pressure directly over the puncture site and/or the use of closure devices or sutures. Closing the radial artery requires only a plastic band, which looks like a bracelet with a pillow inside. It is placed over the puncture site, closed with Velcro, and then inflated to create enough pressure to seal the artery. The band stays on for approximately two-and-a-half hours.
Third, recovery time is faster. Following a femoral catheterization, patients are required to lay flat on their backs with minimal movement for four to six hours. Once patients are discharged home, they continue to face restrictions for one week, including limited bending and lifting. Following a transradial catheterization, patients have complete mobility and can go home in as few as two to three hours. During recovery, they can sit up in bed, take a walk, use the restroom, and even eat a meal. Their only restriction is to avoid driving or lifting anything heavy for 48 hours.
Dr. Shine, who has performed thousands of catheterizations over his nearly 20-year career, says he thoroughly evaluates patients to determine whether the radial artery can be accessed for the procedure. This evaluation includes checking the patient’s radial and ulnar arteries, both of which supply blood to the hand. “You have to make sure that both arteries that go into the hand are in good shape,” explains Dr. Shine. This is to ensure continued blood flow to the hand if, in very rare instances, the radial artery closes during or after the procedure. In other cases, Dr. Shine notes a patient’s radial artery might not be healthy, large, or open enough to withstand the catheter. Other circumstances that might prevent use of the radial artery involve recent access through this site, a patient’s anatomy and some individuals who have undergone bypass surgery.
After examining Angelo, Dr. Shine determined he was a good candidate for a transradial catheterization. Learning this news made Angelo a lot less anxious going into the procedure. “I knew I wasn’t going to have that pain in my groin area, and I wasn’t going to be all black and blue,” he recalls.
Angelo’s transradial catheterization involved inserting a tiny pin-sized micro-puncture needle into his radial artery. Upon inserting a small wire through the needle, Dr. Shine removed the needle entirely. He proceeded to insert a soft, plastic sheath into the artery over the wire and then removed the wire. Under X-ray guidance, he advanced the catheter into Angelo’s aorta and injected contrast dye that flowed into the coronary arteries to evaluate the blood flow to his heart. “I felt just a little pinch, and then never anything more,” Angelo remembers. He also appreciated the two nurses assisting with the procedure that put him at ease by engaging in conversation about his four grandchildren. “It was very comforting to me to talk about different things,” he recalls.
Angelo’s experience following the transradial catheterization was completely opposite from his first one through the femoral artery. Instead of some bruising and tenderness at the site, the only visible sign that a catheterization took place was the small plastic band around Angelo’s wrist. He said the band was much more comfortable and less restrictive than having to endure painful pressure on his femoral artery. His recovery was far more pleasant as well, as he sat and visited with family members for a couple of hours versus lying flat on his back for six hours.
One week after the procedure, Angelo says the only evidence that he even underwent the catheterization is a small mark on his wrist. Today, he says life couldn’t be better, and he’s thankful to be able to spend time with his family. He’s also thankful that Milford Regional now offers the transradial catheterization. “It’s a whole lot easier,” he affirms. In Angelo’s mind, it’s definitely the way to go.