Benefits of a New Approach

Gaylord Davis

Several years ago, recovery from a heart catheterization procedure required Gaylord “Dave” Davis to lie flat on his back for six long hours – something he didn’t ever want to do again. “You can’t roll or move,” says the 64-year-old semi-retiree from Eldon, Iowa.

Fortunately, there was no such discomfort this spring after it became necessary for him to undergo two new heart catheterization procedures with stent placements at University of Iowa Hospitals and Clinics.

After doctors used the wrist-access approach for the first procedure, Davis was so pleased he wanted to make sure the wrist approach could be used the second time as well. “What a difference!” he says. “I could have gotten up off the table and walked home, it was that simple. For me, it’s so much better I can’t even describe it.”

Davis says he feels great, too. “I certainly have more energy than before. I’m trying to be careful and do what the doctors tell me. It’s made a really big difference!”

How the wrist band procedure works

When looking for blockages in the heart, doctors have traditionally used the groin to insert a catheter (a long plastic tube) into the heart arteries. Afterwards, manual pressure is applied to the needle insertion point for 15 minutes and the patient has to lie flat for several hours to make sure there is no bleeding from the site.

Now there’s a relatively new way to do the same thing—using the wrist instead of the groin. A small pressure band is applied to the wrist and the patient can go home soon thereafter. This optional approach—called transradial catheterization—generally means a quicker recovery, less discomfort, and less bleeding risk, says Elaine Demetroulis, MD, a cardiovascular medicine specialist with the UI Heart and Vascular Center.

“Patients can sit up immediately and a simple band around the wrist can be used to keep pressure on the artery,” she says. “It’s more convenient and comfortable for the patient, and there is far less risk of potentially serious bleeding complications.” The wrist-based procedure can also be used for, and is actually preferable, in patients on blood thinners. In addition, it can be used for patients who have difficulty resting on their backs for a long time because of back or other types of pain.

“Although the transradial procedure requires the doctor to make the catheter follow a thinner and sometimes more circuitous path, the procedure is generally overall more comfortable and results in fewer bleeding complications for patients,” Demetroulis says. These advantages, plus potentially shorter hospital stays, should also help reduce overall cost in the health care system.

While most people needing a cardiac catheterization would be candidates for the wrist-access approach, each patient must be evaluated individually to determine the most appropriate strategy. Transradial cardiac catheterization was first performed experimentally in the 1960s but did not begin to be used more widely—primarily in Europe and elsewhere—in the 1990s. The wrist-access approach is still less common than the groin approach in the U.S., but the wrist approach is gaining favor because of some of its unique benefits.