Angiograms: It's All In The Wrist?
ROCHESTER, Minn. (WCCO) -- Millions of times each year, doctors thread a catheter, a thin wire, through patients' veins to find and fix heart problems. It sure beats open heart surgery, but, still adds up to millions of overnight hospital stays so medical staff can monitor patients for excessive bleeding.
Joseph Ole Tranby remembers the first time doctors performed a procedure through the femoral artery in the groin. In addition to spending the night in the hospital, he recalls the discomfort.
"Oh, it hurt too beat the band," Tranby said. "I won't say it the way I'd like to say it."
"Patients typically need to lie flat for many hours after the procedure," said Interventional Cardiologist Rajiv Gulati of Mayo Clinic. "There are higher rates of bleeding. The [femoral] artery's under high pressure. And often [patients] don't know they've bled until they've bled quite significantly."
"I could actually see the bruising there," recalled Tranby. Then he pointed to his wrist with a smile. "I don't think I had any bruising here at all."
The last time Tranby was on the procedure table his doctor accessed the heart through his wrist. Gulati said using the smaller radial artery greatly reduces the risk of bleeding and complications.
"And you'll see here how the dye fills up the radial artery and if you continue that, that goes all the way around, over the collar bone and down into the heart," he said.
Accessing the heart through the wrist was proven to work in Europe in the late 1990s. It became the preferred method there through the 2000s, but was a lot slower to catch on in the U.S.
"In the U.S., up until a couple of years ago, the rate was approximately 2 to 2.5 percent of all cases and more recently has increased to about 8 percent," said Gulati.
He said Mayo is now using the radial artery in the wrist to access the heart in about half of all patients who are good candidates.
This particular case involved opening a blockage in the right coronary artery with a stent. A pressurized wrist band is the final step.
"So that bubble (of air) will press on the vessel to stop it from bleeding after we take the sheath out," said Gulati.
Because the procedure is in the wrist, Gulati said the patient will "be able to get up straight away, walk around, use the bathroom, do whatever he wants to do. And then we'll all be done and he'll be going home later on today.''
Many heart patients are on blood thinners to reduce the risk of blood clots that can cause heart attacks and stroke.
They have to stop taking those meds in advance of having standard angioplasty but not when using the smaller wrist artery.
