More than 1 million cardiac catheterizations are performed in the United States annually, and most of these procedures are performed via the femoral arteries through the groin. With transfemoral catheterization, patients must lie flat for 4 to 6 hours after the procedure. This is necessary to ensure the puncture site reaches hemostasis and to prevent bleeding complications. Transfemoral catheterization can be painful for patients once the procedure is completed because there is a need to compress the artery for 20 minutes manually. The decreased mobility after the procedure can also lead to other problems during hospitalization.
An alternative approach that is being used by more and more clinicians nationwide is transradial catheterization. In these procedures, the coronary arteries are accessed via the wrist, enabling patients to become mobile almost immediately after the procedure. After the surgery, patients can walk, sit upright, use the bathroom, and eat and drink more quickly than with the transfemoral approach. The transradial approach has also been associated with lower complication rates and increased patient comfort. The complication rate for the transfemoral approach varies but can be as high as 3% to 5%. For transradial approaches, the rate drops to less than 1%. In addition, the bleeding associated with transfemoral approaches can be more dangerous than for that of transradial procedures.
History of Transradial Catheterization
The first transradial diagnostic catheterization was performed in the late 1980s in Europe. In 1993, a research team in Amsterdam began using the technique for interventional procedures. In recent years, the methods for catheterization have become increasingly enhanced. Some interventional cardiologists view transradial catheterization as the optimal choice for a significant segment of the patient population. Small but significant changes can have a great impact on medical outcomes, costs, and patient satisfaction. By changing the access points for catheterization, patients, hospitals, and medical centers can benefit from improved outcomes and reduced healthcare utilization.
In women, the elderly, those with peripheral vascular disease, and obese patients, transradial access can reduce the risk of bleeding complications by 50% or more when compared with transfemoral access. Transradial access can also be done in patients who had previous bypass graft surgery, but this is not an ideal situation. In women with smaller anatomy, clinicians should use caution when performing transradial procedures because the arteries can spasm.
Important Considerations for Transradial Catheterization
One of the caveats of transradial catheterization is that it can be somewhat more cumbersome and time consuming for physicians to perform. It requires training, expertise, and a longer learning curve. Major complications associated with transradial interventions include early and late artery occlusions that are usually undetected. Despite this caveat, the benefits of transradial catheterization outweigh many of the risks when performed by experienced interventional cardiologists. In addition to decreasing the incidence of major entry site complications, these procedures minimize the risk of nerve damage, which is common in the femoral approach due to the close proximity of the femoral artery to surrounding nerves.
The improved overall patient comfort and satisfaction associated with transradial access cannot be undervalued. These factors can lower post-procedural costs because there’s a reduced need for follow-up visits.
Readings & Resources (click to view)
Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn. 1989;16:3-7.
Kiemeneij F, Laarman GJ, Odekerken D, et al. A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approaches: the ACCESS study. J Am Coll Cardiol. 1997;29:1269-1275.
Rao SV, Eikelboom JA, Granger CB, et al. Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28:1193-1204.
Schussler JM. Effectiveness and safety of transradial artery access for cardiac catheterization. Proc (Bayl Univ Med Cent). 2011;24:205-209.
Jen HL, Yin WH, Chen KC, et al. Transradial approach in myocardial infarction. Acta Cardiol. 2011;66:239-245.
Hamon M, Mehta S, Steg PG, et al. Impact of transradial and transfemoral coronary interventions on bleeding and net adverse clinical events in acute coronary syndromes. EuroIntervention. 2011;7:91-97.