By: Dr. Joseph Pedone
What is a cardiac catheterization?
Cardiac catheterization is a method doctors use to perform a range of tests and procedures in order to diagnose and treat coronary artery disease and other cardiovascular conditions. Cardiac catherization is one of the most accurate tests in the diagnosis of coronary artery disease.
What is involved in a cardiac catheterization?
A long thin tube (catheter) is snaked through the arteries from the wrist, arm or leg and advanced toward the heart in order to determine if and where there are blockages that can affect the flow of blood to the heart muscle. Catheterizations can be either diagnostic or interventional.
How many catheterizations are performed in the United States per year?
There are more than one million procedures performed each year.
What is angioplasty?
Angioplasty is an interventional procedure that uses a balloon-tipped catheter to open a blockage. The final step of this procedure may be to place one or more stents (mesh tube) in the artery to help keep the vessel open.
Is there more than one way to gain access into the arteries in order to perform these procedures?
Yes, there are three different access strategies:
What is transradial access?
Transradial access uses the radial artery, found in the wrist, as an entry point for diagnostic and interventional cardiovascular procedures.
When and where did transradial access get its start?
In the late 1980’s, a French-Canadian physician, Dr. Lucien Campeau, began using the right radial artery as an entry point for diagnostic procedures. This artery, while slightly smaller than the femoral artery, is large enough to allow most catheters to enter and reach the heart.
By 1993, a group in Amsterdam, led by Dr. Ferdinand Kiemeneij, began using the transradial technique for interventional procedures. While initially somewhat limited by available equipment, this is not the case today, with small catheters and stents, most products today can be delivered transradially.
How does transradial access compare to femoral access?
Both techniques provide viable access options to the physician performing diagnostic and interventional cardiac procedures. Each technique has perceived benefits and some limitations. When a transradial access procedure is selected, patients generally experience less back pain and faster ambulation (ability to be on their feet post procedure) than patients having femoral access, which requires the patient to lie flat for four-to-six hours and have consistent compression applied to the groin to stop the bleeding post procedure. Actual procedure time and procedure costs are considered comparable.
Is one access method better than the other?
Femoral access is the most popular method used in the United States. The primary reason is this is habit. Most physicians who perform diagnostic and interventional procedures today were trained on this method and may lack training or experience with other access methods. As a result, it is considered their default access strategy.
While femoral access is used most often in the U.S., there are challenges and limitations with this strategy, which can impact outcomes, patient satisfaction and healthcare costs, including:
The radial artery, which is found in the wrist, provides an alternative access point. Successful use of the radial artery (transradial access) offers some unique advantages, but does require operator to learn and become proficient with a different access skill set. Benefits include:
Can transradial procedures be performed in all cases?
No. There are some situations where transradial access is not possible and may require the operator to use either a femoral or brachial approach.
How does a physician choose between the femoral and transradial approach?
The transradial approach requires specific training on the procedure in order to give physicians experience and confidence in the skill required for this procedure. For physicians trained on both procedures, multiple factors are considered, including the complexity of the case and size of products to be delivered, a patient’s weight and prior procedures, including the presence of pre-existing bypass grafts in certain areas of the anatomy. Finally, if a physician prefers the transradial approach, there are several quick tests that can be performed to ensure a dual supply of blood in the hand.
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