Transradial cardiac catheterizations reduce complications, increase patient comfort

Each year, more than one million cardiac catheterizations are performed in the United States, and most of these procedures are performed through the groin to access the arteries that provide blood supply to the heart. Now, 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. Called "transradial access," this emerging approach has increased 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, and Interim Chief, Division of Cardiovascular Diseases, Director of the Cardiovascular Catheterization Laboratories, and Co-Director, Stony Brook University Heart Center. "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."

Lora Holdorf, 51, of Shirley, said her recovery from transradial catheterization at the Stony Brook University Heart Center was "comfortable and quick" and served as an important step in clearing her as a healthy candidate for a non-heart related surgical procedure.

"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 and for cases like Ms. Holdorf.

For both groin (transfemoral) and wrist (transradial) catheterizations, once the artery is engaged, the diagnostic and interventional procedures are virtually the same. One major difference, however, is what happens at the end of each procedure. With groin access, the patient must lie flat for four to six hours after the procedure. This is necessary to ensure the puncture site reaches hemostasis (no further bleeding). 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 at Stony Brook and worldwide interventional 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, and reduced post-procedural costs resulting from fewer complications and/or follow-up visits.