Wrist Catheterization
Videos
Oct 27, 2014
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Srikanth Sadhu, MD discusses wrist catheterization (radial artery catheterization).
Wrist Catheterization
My name is Srikanth Sadhu. I’m one of the interventional cardiologists at the Advanced Cardiovascular Institute. Our office is in the Atrium Medical Center
What is Catherization?
Any catherization means you are putting small tubes in the arteries to the heart and injecting liquid dye to take pictures of your heart arteries. It can be done from the groin or femoral artery or from the radial artery from the wrist. The wrist artery has been done for a long time but it is catching up in the U.S. Only less than 10 percent of cases in this country are done through the radial axis or the radial artery axis.
Advantages of Catherization through the Wrist
We have more and more studies coming up now showing the risk of bleeding is lower with radial axis, the patients can go home sooner, the quality of life is better. The cost is being cut with radial procedures because send the patient home earlier. You don’t have same costs as you do from the groin. If you do it from the groin you have to lie on your back from two to 10 hours and there is a significant risk of bleeding from the groin even though it is still low. Compared to the radial there is more bleeding from the groin than from the wrist. And we have more studies that say that is the case now. A recent study that was published about a randomized control trial showed a 63 percent reduction in major bleeding and, especially in the setting of a heart attack, that’s a significant reduction in mortality which means chance of death. So more and more people are moving toward the radial because of cost, because of comfort, because of patient inquisitions.
Candidates for Radial Artery Catherization
Most procedures can be done through radial. Ninety-nine percent of the things you do through the groin can be done through the radial artery. Success rate is more or less the same whether you go in from the wrist or the groin – 95 percent according to major studies. You cannot put much bigger catheters – six gauge – from the wrist but 90 percent of the procedures we can do from the wrist so we can do all those things from the wrist. We can do balloons, stents, and rotablators all from the wrist itself. There are very few things you can not do from the wrist. The limitations are not just the catheter size. The limitations are the radial artery is small and prone to spasm which means it clamps down on the catheter and makes the procedure more difficult. The physician needs a little more learning curve because it’s more technically challenging – 200 cases learning curve before someone is proficient in doing these cases. Small, older women sometimes have more ???? which makes it more difficult. Those are the main procedural limitations. Also we should talk about when somebody should not have radial procedure. If someone has kidney disease and the plan is to do dialysis on them in the next year. The radial artery is sometimes used as a conduit to do the dialysis; then you should not touch the radial artery so it can be preserved for future dialysis purposes. Similarly if someone is planning on having a bypass and the site you want to do the radial artery, take the radial artery as a bypass graft, then you should not touch the radial artery because you can jeopardize the future use of the radial artery.
The Risk of Using the Wrist
There is no added risk compared to the femoral artery. Anytime you do a heart cath, the risk inside the heart is the same as the groin artery. You have one in a thousand risks of any major complication you can think of either from the groin or from the wrist. The risk of bleeding is much less compared to the groin. The only complication you should be aware is severe spasm. If you are not aware of this and you try to thread a catheter through a tightly narrowed spasmodic artery this can cause problems. A gentle approach, as long as you are aware of all the anatomical differences like the bends and curves in the area, you can do the radial artery cath with much less risk compared to the groin.
Procedure Explanation
The radial catherizations are done in the cardiac cath lab at the Atrium Medical Center. The procedure takes less than half an hour to do the whole thing. The access takes two to three minutes and the procedure takes about 15 to 20 minutes. Once the procedure is done the recovery time is much shorter compared to the groin access. It’s less than two hours even if you get a stent done which is more than 10 hours difference from the groin access.
Is Hospitalization Necessary?
Diagnostic heart caths where you just look for blockages are outpatient procedure strictly. Most interventions which mean the balloons and stents that are done in America are still inpatient especially if you are doing them from the groin. You stay over night and go home because of the risk of bleeding whether you are doing a balloon or a stent you are on a lot of blood thinners and that increases the risk of bleeding from the groin significantly. But from the wrist a lot of places, including where I’ve done this procedure before, we sent patients home the same day because the risk of bleeding is diminished from the wrist so you do the procedure in the morning, you observe them for five or six hours – they’ve been walking around during this time – you get some blood tests done and if everything’s fine you go home in six hours on the same day. That significantly reduces the nursing cost, the hospital cost and even the patient comfort because they want to go home the same day. That’s one of the biggest advantages of stents being done through the radial axis.