"The advantages were clear. When we saw one of our Heart South cardiologists using radial access for caths and stents, we all wanted to learn. Now we do 70 to 75 percent of our caths and stents using the radial approach," Clifton Vance, MD, of Hearth South said.
"The risks for bleeding and other complications are lower, and it saves our patients a lot of discomfort, especially people who have back pain and find it difficult to lie flat for an extended period. With the radial approach, they will soon be sitting up in bed. They will also likely be up walking and ready to go home sooner."
Radial access may also be easier for larger patient with deeper femoral arteries that are difficult to palpate. However, there are some patients who may do better with a traditional femoral approach.
"We always test blood flow to the hand to make sure it is adequate so we don't risk compromising circulation," Vance said. "Some people may have poor flow or an unusually twisted structure to their arteries that might make threading the catheter difficult. We usually use the right wrist since cath labs tend to be laid out to work from the patient's right, but we can access through the left if needed to get around a problem."
The catheter is inserted in the wrist.
Training to use radial access is much like becoming adept in any other procedure, but there is a bit of a learning curve.
"We use a different catheter, a different pathway and different medication to prevent artery spasms," Vance said. "Most of all, it takes a different muscle memory, like learning to tie your shoes, which becomes automatic with practice. Once you have become proficient, the radial approach is as fast or faster than the femoral approach. The improvement in patient comfort and satisfaction make it a technique that is well worth learning."
Radial access can be used in scheduled procedures or emergencies for diagnostics or to place stents opening up blood flow in and near the heart. Femoral access is still the preferred route for ablations and some of the more complex percutaneous procedures.
Heart South cardiologists perform cath and stent procedures at Shelby Baptist Medical Center and prefer to use a radial approach whenever possible.
"Radial access has been growing in popularity over the past six or seven years, but unfortunately, it is only being used about 20 percentage of the time in some areas. I'm looking forward to this option being available to everyone who is a good candidate for a radial approach," Vance said.
Response from Heart South patients has been very positive.
"A few have heard of going through the wrist for a cath or stent and they specifically ask for this approach, but for many it's a new idea," Vance said. "When we explain it, they are usually just glad to hear that they won't have to be uncomfortable for hours laying on their backs. Our patients who have had these procedures before are especially pleased."