When Geneva Walters, 79, suffered a heart attack, her doctors soon found that her case posed special problems.
Normally, to examine blockages in her arteries, cardiologists would have inserted a catheter tube into the large femoral artery in her leg, near the groin, and threaded it up to her heart. But due to the complexity of Walters’ coronary disease—and her previous lower-extremity surgery—performing this traditional cardiac catheterization procedure was not an option.
Instead, cardiologist Timothy Ball, M.D., who examined Walters at Carilion Roanoke Memorial Hospital, proposed a different path to her heart: through the smaller radial artery in her wrist.
Walters, who had traveled to Roanoke from her home town of Princeton, West Virginia, was ecstatic to learn she had an alternative.
Radial catheterization, as this procedure is called, is increasingly being favored by cardiologists such as Dr. Ball, who cite its increased comfort and safety. Some studies have also found it to result in fewer complications than the femoral approach.
Dr. Ball, who recently came to Carilion Clinic from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, is a firm believer in the procedure. “The radial artery is a more patient-friendly access point,” he says. “I prefer to use the radial artery if possible because it is associated with lower bleeding risk, more patient comfort, shorter recovery time, less risk of nerve trauma, and lower rates of complication.”
“Some patients are not good candidates for the traditional femoral catheterization,” he says. This may be due to their weight; back or spine problems; peripheral artery disease; or restless legs syndrome. “The radial approach can be very beneficial for those patients,” Dr. Ball says.
Unlike the femoral approach, which requires patients to lie on their backs for several hours after the procedure to prevent bleeding, the radial approach allows patients to get up and move around right away.
“Patient response to this procedure has been great,” Dr. Ball says. “Personally, my favorite aspect is having my patients be able to get up and walk with me immediately afterwards to the recovery room.”
Also, when bleeding complications occur using the femoral approach, bleeding into the leg can be slow, subtle, and hidden until a large amount of blood is lost. If a similar complication occurs using the radial artery, bleeding can be seen immediately near the skin and can be easily controlled by firm external pressure. Bleeding complications are seen in five to eight percent of femoral cases, compared to one to two percent of radial cases.
“There is an increasing body of data over the last five years showing that bleeding complications are a predictor of mortality and morbidity,” says Dr. Ball. “Anything you can do to minimize bleeding is encouraged, and bleeding complications are markedly reduced through the use of the radial artery.”
Roanoke Memorial, which performs thousands of catheterizations annually, has six catheterization labs, making it one of the largest such facilities in the state. Dr. Ball is one of the cardiologists there who can perform catheterization either through the femoral or radial approach.
Throughout the United States, less than five percent of hospitals now perform radial catheterizations. They are technically more difficult because the radial artery is significantly smaller than the femoral artery, and cardiologists are required to go through extensive training to master the procedure.
In treating Walters, Dr. Ball was able to use the radial approach to reach her heart, and he injected a dye through a catheter tube to identify cholesterol deposits in her diseased arteries. A stent was then inserted to stabilize the arteries, restoring blood flow.
“I was so happy afterwards that I felt like hugging Dr. Ball,” Walters says. “It was amazing. I got up right afterwards and felt fine. Everyone there was wonderful.”
Radial catheterization is not for every heart patient, however, cautions Dr. Ball. In patients where the radial artery may be used as a conduit for bypass surgery, or in those with arteries too small or too tortuous to pass the catheters, the radial approach cannot be used.
But for many patients—such as Geneva Walters—the radial approach has proved to be a life saver.
Spring / Summer 2011