You’ve probably heard the term angiogram before. This is a procedure whereby a catheter, or small flexible tube, is inserted into a patient’s arterial circulation. This allows a cardiologist to examine the patient’s coronary anatomy and detect blockages in the arteries. As an interventional cardiologist, one of my specialties is using angioplasty to open these blockages and restore blood flow to the heart.
The question arises, what is the best approach to angiography? In other words, where is the best location on the body to insert the catheter into the arteries?
Most physicians in the United States use the femoral approach. This consists of making an incision near the groin and placing the catheter in the femoral artery. The femoral approach is generally safe and effective. However, there is a more inviting alternative.
The transradial approach consists of making an incision at the wrist and placing the scope in the radial artery. Transradial access was first described for coronary angiograms in 1989. Transradial angioplasty came along quickly thereafter. Transradial access is widely used worldwide, but in the U.S., the femoral approach is much more frequently employed.
There are numerous benefits when using the transradial approach. It decreases all causes of mortality. Significant decreases in major vascular complications are also noted. Ischemia to the hand is rare. Transradial access is an ideal option for high risk patients such as morbidly obese people, those with anemia, or those suffering from chronic kidney disease. Shorter hospital stays are often noted using the transradial approach. Same-day discharge after angioplasty is now common and safe, in the right setting.
Why hasn’t this technique been more universally adapted by the United States interventionalist? Potential complications include arterial occlusion and compartment syndrome. In addition, a lack of knowledge or context with the technique is a potential barrier. However, the risk of stroke is low and comparable to the femoral approach. While there is a learning curve present, it is not insurmountable. Having a good mentor for a number of cases is advised. Also one must remember that it is OK to default to a femoral approach.
Other attractive features of the transradial approach include earlier time to ambulation and a return to normal activities. You can literally walk out of the cath lab when the procedure is done.
One can’t forget how important the tools are that we use daily. Industry and technology work collaboratively to produce more successful results with lower risks.
I’ve been using the transradial approach for angiography and angioplasty for 20 years now. It has made me a better cardiologist. Thanks to new tools and techniques, we can positively influence outcomes in the cath lab.
If you’ve been advised to have an angiogram, be sure to ask your cardiologist about the transradial approach.