Sylvia* was very nervous about her upcoming cardiac catheterization. She had been through the procedure before and remembered being uncomfortable lying on her back for several hours afterward. So she was pleasantly surprised when her cardiologist told her he would be able to do the procedure through an artery in her wrist and that she would not have to stay on her back afterward.
Cardiac catheterization (often called coronary angiography) is a procedure for examining the arteries of the heart, and is often used to find blockages that could cause chest pain (angina pectoris) or even a heart attack. This procedure traditionally requires threading a long, thin, plastic tube (catheter) through an artery in the top of the leg and into the main artery of the body. Your doctor and medical staff then inject x-ray dye into the catheter and trace it as it flows into the arteries to determine if there are any serious blockages. Often, your doctor will fix the blockages right away, through the same tube, using a balloon or stent (a small, spring-like device that holds open a blocked artery). While catheterization is a safe procedure, concerns about bleeding in the leg artery after the tube is removed require patients to lay flat on their back for several hours after the procedure.
A new approach to catheterization involves using the radial artery in the wrist instead of a leg artery. Patients who undergo this procedure can stand up and walk around immediately after procedure. They are more comfortable, have less bruising where the needle was inserted,1,2 and have fewer problems with blood flow in the artery that was used for the procedure. Additionally, radial artery catheterization has been shown to have lower rates of death and severe complications as compared to leg artery catheterization.3,4
Radial artery catheterization is not possible for every patient and may not work for you if:
- You have only one artery in your hand (from either being born that way or a hand injury or surgery)
- Your radial arteries are too small.
- You have undergone certain types of heart surgery, such as coronary bypass.
- Your radial artery or chest arteries are not straight enough to pass a catheter through.
If you are having a cardiac catheterization and are interested in using the radial approach, your cardiologist will discuss the benefits and risks and help you come to the decision that is best for you.
* Not the patient’s real name.
1 Kiemeneij F., Laarman G.J., Odekerken D., Slagboom T., van der Weiken R., “A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the access study,” Journal of the American College of Cardiology Vol. 29, May 1997: 1269-1275
2 Brueck M., Bandorski D., Kramer W., Wieczorek A., Höltgen R., Tillmanns H.; “A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty,” Journal of the American College of Cardiology: Cardiovascular Interventions Volume 2, Issue 11, November, 2009: 1047-1054
3 Mamas MA, Ratib K, Routledge H, Fath-Ordoubadi F, Neyses L, Louvard Y, Fraser DG, Nolan J.; “Influence of access site selection on PCI-related adverse events in patients with STEMI: meta-analysis of randomised controlled trials,” Heart, Volume 98, Issue 4, February 2012: 303-11.
4 Joyal D, Bertrand OF, Rinfret S, Shimony A, Eisenberg MJ., “Meta-analysis of ten trials on the effectiveness of the radial versus the femoral approach in primary percutaneous coronary intervention,” American Journal of Cardiology Volume 109, No. 6, 15 March 2012: 813-8.