Heart Catheterizations Through Wrists Reduce Complications

Most of the 1 million heart catheterizations performed each year in the United States are performed by accessing arteries to the heart through the groin. But interventional cardiologists at the Stony Brook University Heart Center and elsewhere are performing more heart catheterizations by going through the wrist instead of the groin, a process called "transradial access." The procedure has several advantages for patients including reduced complications, increased patient comfort, and quicker recovery time.

“We are expanding our use of transradial access for both diagnostic and interventional procedures to ensure better patient outcomes and comfort,” says Luis Gruberg, M.D., Professor of Medicine, Division of Cardiovascular Medicine, Stony Brook University School of Medicine. “As a general rule, patients and their referring physicians have embraced this procedure, as it enables the patient to be mobile and sitting up much faster after the procedure and with less post-procedure pain.

“Small but significant changes can have a great impact on medical outcomes, costs, and patient satisfaction, and a change in access points for catheterization is one of these,” adds Dr. Gruberg, referring to growing use of transradial access at the Heart Center.

Once the artery is accessed, the diagnostic and interventional procedures are virtually the same for both groin (transfemoral) and wrist (transradial) catheterizations. With groin access, however, the patient must lie flat for four to six hours after the procedure. This is necessary to ensure that there is no bleeding from the puncture site. With wrist access, patients are able to get up almost immediately after the procedure, allowing them to walk, sit upright, use the bathroom, and eat and drink.

The first transradial diagnostic catheterization was performed by Dr. Lucien Campeau, a French/Canadian physician, in the late 1980s. By 1993, a research team in Amsterdam, led by Dr. Ferdinand Kiemeneij, began using the technique for interventional procedures. In recent years, the method for catheterization has grown and is seen by some interventional cardiologists as an optimal choice for a significant segment of the patient population.

Dr. Gruberg emphasizes that transradial access may have special benefits for women, the elderly, those with peripheral vascular disease, and obese patients. For example, he says, while the transfemoral approach is more common in the United States, the entry point is sometimes difficult to access and has a greater associated risk of complications, including bleeding — especially in women. In women and these other patient groups, Dr. Gruberg estimates transradial access reduces the risk of bleeding complications by 50 percent or more in these populations, compared to transfemoral access.

He reports that cardiologists typically see the following benefits of transradial access procedures over transfemoral ones:

• Decreased incidence of major entry site complications, mainly bleeding

• Minimized risk of nerve damage, which is common in the femoral approach due to the close proximity of the femoral artery and nerve

• Easier vascular access for interventional cardiologists and closure of the needle puncture in certain patients, such as those who are overweight or obese

• Significantly decreased time to patient ambulation and discharge, as well as shorter hospital stays

• Improved overall patient comfort and satisfaction

• Reduced post-procedural costs resulting from fewer complications and/or follow-up visits.