If you have had a cardiac catheterization from the femoral (groin) approach, you have received advanced quality care. You have also experienced the challenge of recovery from a groin puncture. This experience may have been uneventful and accompanied by minimal discomfort as is the experience for the vast majority of patients undergoing cardiac catheterization from this approach. You may have had the femoral artery closed with a special device that limited the amount of time you were required to be at rest. This is the expected course of events and is the outcome most U.S. cardiologists strive for and achieve.
So, why consider a change in approach? There are three reasons to consider a change:
- Patient comfort
Let’s consider safety. When things go as planned and expected with the femoral approach, outcomes are wonderful. As with all procedures, including transradial cardiac catheterization, there is a risk of complications with the femoral approach to cardiac catheterization. The major risks are bleeding and injury to the artery. Powerful blood thinners are used during cardiac catheterization, especially if interventions such as stent placement are undertaken. With the puncture of an artery, there is always the risk of bleeding. The femoral artery is a larger and more difficult artery to compress and control than the radial artery. Recognized complications include hematomas (collections of blood in the tissue around the artery) and pseudo aneurysm (balloon-like out pouches in a layer of the arterial wall). These problems are usually more uncomfortable and annoying than life threatening but bleeding can be catastrophic. These complications are less common and less threatening in transradial approaches. Injury to the radial artery can also occur, but thrombosis or clotting off of the radial artery is the more common significant complication of this approach. The thrombosis of the radial artery is often without symptoms or requiring specific action.
Most patients undergoing femoral catheterization are kept at bed rest for 2 to 4 hours to lessen the risk of bleeding and arterial injury after the procedure. Transradial patients are allowed to sit up and walk as soon as the sedation given during the procedure has worn off. This is important to patients with back or breathing issues. Quicker and more comfortable mobility are important to many patients.
Fewer severe complications and early mobilization results in shorter, less expensive hospitalizations. While on a private, individual (out of pocket) basis this consideration may not seem relevant, on a larger volume basis the cost savings are substantial.
The transradial approach is not advisable or possible for all patients. The radial artery may be too small to pass a catheter or may go into spasm when accessed. This can cause pain for the patient and an inability for the operator to pass the catheter. Anatomical anomalies in the arteries between the radial puncture site and the coronary artery, or other target vessel, can prevent passage of the catheter to the needed site. Patients with previous bypass grafting may be more difficult to perform cardiac catheterization from the transradial approach. The femoral approach may be the better choice for these and other circumstances.
Is the transradial approach for cardiac catheterization right for you? Maybe. Factors benefit and risks must be considered on an individual basis. Discuss it with your doctor. I have developed a special interest in and have a preference for this approach to catheterization.
Ricky L. Harris, DO, FACC