Family Health: A different approach to cardiac catheterization

Cardiac tests and treatments today are so sophisticated that watching blood circulate through the heart in real time no longer seems remarkable. In fact, it happens more than 1 million times a year in the U.S., during a procedure called cardiac catheterization.

That makes this procedure common, but cardiac catheterization is far from ordinary. It has minimal risks and it helps many people live longer, healthier lives. And a new technique called transradial cardiac catheterization makes it even safer – and more comfortable – than before.

In a cardiac catheterization, or “heart cath,” a cardiologist threads a long, thin tube called a catheter through a vessel to the heart. After injecting a special dye into the catheter, the physician uses a computer monitor to see blood flowing through the heart’s vessels.

Catheterization is also used to open narrowed arteries with balloon angioplasty and to place stents to keep them open.

The traditional approach is to start the catheter in the femoral artery, in the upper thigh. While most heart caths are still done this way, a newer technique called transradial cardiac catheterization is gaining popularity. In this approach, the catheter is inserted instead into the radial artery in the wrist.

Both methods are very safe. According to the American Heart Association, however, using the wrist artery has these advantages:

  • The risk of internal bleeding is greatly reduced. That’s because the radial artery is closer to the skin surface, and any bleeding is easily identified and treated. The femoral artery is both larger and deeper, and internal bleeding can become severe before it’s found. This is uncommon, but it can require blood transfusion or surgery to repair the artery.
  • Recovery time is much shorter and more comfortable. After a heart cath with the femoral artery approach, patients must lie very still on their backs for several hours. That’s especially difficult for people with back problems or who have trouble breathing. With the wrist approach, patients can sit up. They often go home the same day, while patients who have had the femoral approach usually stay overnight.
  • Less pain medication is required after the procedure.
  • Since patients can get up and use the restroom, they don’t need to be catheterized to urinate.

Problems are rare with transradial cardiac catheterization, and it’s made even safer by precautions that protect the patient. For example, cardiologists first make sure there is adequate circulation to the patient’s hand through the ulnar artery. That ensures the hand will get enough blood if the radial artery becomes obstructed during surgery. Patients also receive medications to relax the artery, which helps avoid a spasm that could make inserting instruments difficult. And the team is always prepared to switch smoothly to the femoral artery if necessary.

Transradial cardiac catheterization is especially useful when the patient is taking anti-coagulant medicines that raise the risk for bleeding. It’s also helpful in patients who are obese, since extra weight makes the femoral artery harder to access and to monitor afterward. At the Montana Heart Center at Community Medical Center, the majority of cardiac catheterizations are now done with the transradial approach.

People who have had a previous heart catheterization via their femoral artery are often surprised at how comfortable the procedure is with the wrist artery approach. Along with its other advantages, patient comfort is likely to secure this procedure a bigger share of those 1 million cardiac catheterizations each year.

You can learn more about this on our Missoula Interventional Cardiology page.

David Jinich is an interventional cardiologist with Community Physician Group at Community Medical Center.