Reaching the Heart through the Wrist

The Advantages of Transradial Catheterization

Reaching the Heart through the Wrist

When a coronary angiogram was recommended to 47-year-old Nelson Lacap, he sighed as he thought about the discomfort, the risk of complications, and days of hospital confinement.

An angiogram, also known as cardiac catheterization, is usually performed to investigate the possibility of blocked coronary arteries. Any catheter placement into a blood vessel is associated with a risk of bleeding. The femoral artery in the groin - near where the leg bends from the hip - is one of the blood vessels Interventional Cardiologists most commonly use to insert a catheter (a flexible tube that is smaller than the vessels) and thread it through the arteries to the heart to perform the angiogram.

Nelson was thinking about this traditional approach which makes uses of the femoral site. His doctor, Dr. Michelangelo Sabas, Interventional Cardiologist at The Medical City (TMC), introduced him to the transradial access to cardiac catheterization.

Nelson proceeded with his angiogram on July 17, 2014 at the TMC Catheterization Laboratory (Cath Lab). He arrived at the Cath Lab an hour before his 9 am procedure. The angiogram itself took half an hour.

“I wasn’t in there very long,” said Nelson of the procedure. “With it done in the wrist, I could move around immediately. I was out of the Cath Lab before 12 noon,” he added. Nelson said he literally walked off the catheterization table after his angiogram.

Dr. Sabas explained that after the transradial procedure, patients can sit up, eat, drink, or even walk without fear of causing bleeding at the access site.
“This is helpful especially in patients with chronic back pain or other conditions that may make lying flat difficult,” continued Dr. Sabas. The transradial approach provides a safer alternative to catheterizations – especially for patients with medical conditions which increase bleeding risk such as those who are obese, have peripheral artery disease or are on anticoagulation medicine.

Transradial access for catheterization is obtained by puncturing the radial artery at the underside of the wrist using a small needle, through which a fine wire is inserted into the blood vessel to guide the insertion of a small plastic tube called a sheath. The sheath keeps blood from spurting out of the artery and allows other devices to go into the body’s cardiovascular system. From this access site, doctors can perform coronary angiogram (mapping of the heart arteries) and angioplasty or stenting (opening of blocked arteries).

At TMC, interventional cardiologists had utilized femoral artery as the preferred route for coronary procedures in the past years. The radial artery default access for angiography and coronary intervention at TMC was started in April 2010 by Dr. Sabas and Dr. Paolo Prado and since then, has become the preferred access for coronary procedures by most of the interventional cardiologists.

Dr. Sabas cited the benefits of transradial catheterization, which includes a lower risk of bleeding at the incision site, less risk of major complications that require blood transfusion or surgery, and less hematoma formation after the procedure.

A femoral procedure requires patients to lie flat for about six (6) hours while transradial patients can move around and walk to the bathroom after the procedure. The patient just wears a wrist band to control bleeding. He is merely advised to refrain from doing activities that entail flexing the wrist where the procedure was done for the next 24 hours. Early ambulation and early discharge after transradial catheterization make it more attractive than femoral procedure for elderly patients and those patients with back pain, chronic obstructive lung disease, and prostatic hypertrophy.

Lowered risk of bleeding, early ambulation and discharge translate to significant savings for the patient. When patients are able to ambulate sooner, nursing costs are also lessened.

Procedures such as transradial coronary angiography may actually be done as an outpatient procedure in low-risk patients or those who have no other serious illnesses that require further monitoring in the hospital. The procedure generally takes around 15 to 30 minutes.

In the Philippines, TMC is one of the first hospitals to offer transradial catheterization. TMC Cath Lab currently uses transradial access in almost 90% of its coronary procedures. This is the highest percentage, by far, of all the Cardiac Catheterization Labs in the country and matches the leading centers in Europe and Japan.

The transradial approach to diagnostic and interventional cardiac procedures at TMC Cath Lab is a testament of the efforts of TMC Cardiovascular Center to further improve quality of patient care by offering new and better options aimed at improving patient safety and comfort, and decreasing procedure costs.
For more information about transradial catheterization, you may contact tel. nos. 988-1000 or 988-7000 ext. 6278.–end-