-- J.R.T., of Davenport, Iowa
A. For most American cardiologists, the favorite way to a man's heart for a catheterization procedure is still through his groin.
But a slowly growing number, like Dr. Anil Shah, of Belleville, are no longer hitting below the belt, so to speak. Instead, they are joining much of the rest of the world's doctors by entering through the wrist. It's called a transradial access (TRA) procedure, and it's making a world of difference for patients who go through it.
You only have to look at a list of benefits to see that. Little or no bleeding. No bruising. No long recovery time with a heavy bag on your leg. Little or no pain. Easier access into obese patients. No overnight hospitalization unless, required by another medical problem.
"We had a lady who came in with a heart attack, and I did the procedure from the radial," said Shah, who says he now does all of his procedures through the wrist. "Minutes after the procedure was done, she was texting messages to her family to let them know where she was and that everything went fine. Yes, using the hand and arm in which I had done the procedure. I never thought about it before, really -- that immediately people can do all this stuff."
If you want to hear it from the horse's mouth, just listen to the experience of Eddea Kamp, the director of health information at St. Joseph's Hospital in Highland. Just 45 years old, the Marine woman had been experiencing chest pains for some time. But doctors kept telling her it was nothing because she was young and had almost none of the risks such as high cholesterol or hypertension.
But another round of pain in mid-June resulted in more tests and some startling findings: One of her arteries was 93 percent blocked; another, 99. She suddenly found herself flat on her back in an ambulance being rushed to St. Elizabeth's Hospital in Belleville. Remembering her parents' experiences, she knew what she was likely in for.
"My mom and dad have both had cardiac catheterizations, and they always had done it through the femoral," she said. "I remember them lying there with the sandbag on their groin and having to lie flat for, like, 24 hours."
But Shah had news for her. After checking to determine that she was a good candidate, they prepped her right arm and started the procedure that snaked a catheter through her vessels to clean out one of the arteries and get more blood flowing to her heart.
"I was awake," she said. "They gave me a little bit of medicine to kind of knock me out, so I wasn't feeling any pain. But I can remember seeing the screen and watching them go in with the balloon to open up the vessel."
Her recovery, however, was radically different than her parents'.
"I had to keep my arm still for maybe an hour, and there was a special kind of bracelet that I had to wear that compressed the area," she said. "But it's not bad. I've got mine at home. I thought it was pretty neat. But, yeah, once they deflated that, I was good to go."
She had to stay overnight that time only because she was in the midst of a heart attack when she arrived. Two weeks later, she was back as an outpatient to have her second artery cleaned the same way.
"Now, I just have these tiny, little scars," she said. "They're not even scars, just two little marks, one right on top of the other. I think it's from being out in the sun this summer, and I'm sure they'll go away."
Kamp's reaction is typical of the roughly 250 procedures Shah has done since starting in January.
"All of my patients who have had it from the leg and now from the radial swear to God they would never ever let anyone go from the leg because this is so simple," Shah said. "If they want to have the procedure in the morning and want to go to work in the evening, they can go to work. It's made a big, big impact, and, obviously, more and more hospitals are going to start doing it."
Currently, Shah knows of only two or three hospitals that offer it in the St. Louis area, with St. Elizabeth's the only one in the metro-east. Two of Shah's colleagues at Cardiology Consultants Ltd. -- his brother, Atul, and Dr. Shiyam Satwani -- are doing them as well.
Not that there's anything wrong with the femoral approach, he said. The femoral artery is a larger vessel that offers easy access into and a pathway through the body's circulatory system. That's why it has been the favorite method in the United States since the 1960s for angiograms and interventional procedures. And, some patients might not be candidates for the new procedure because of their circulatory anatomy or other concerns.
In the late 1980s, a French-Canadian physician, Dr. Lucien Campeau, began using the right radial artery as an access point for diagnostic procedures. While slightly smaller than the femoral, it is large enough to allow most catheters to enter and reach the heart. By 1992, Dr. Ferdinand Kiemeneij was doing interventional procedures with his team in Amsterdam. Now, Shah says, doctors in such countries as France, Japan and India do their procedures almost exclusively through the arm.
Shah was trained in the technique about 10 years ago, but much of the equipment was not sophisticated enough for radial procedures. Vessels often would spasm, forcing doctors to switch their procedure to the groin. Now, the catheters are lubricated and can slide through the vessel without irritating it. Still, Shah estimates that only 5 percent of cardiologists nationwide use the technique.
"There is a long learning curve, but people should start doing it," Shah said. "It should become a mandatory thing."
source: bnd
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