Transradial Catheterization Benefits Patients and Physicians

The radial artery is a potentially beneficial entry site for several reasons. In most patients, a connective arch links the radial and the ulnar arteries in the hand, which in turn provides the hand with two sources of blood flow. This dual supply protects the hand during and after the procedure. However, about five percent of the population do not have this connective arch. "The radial and ulnar arteries are connected by the Palmar Arch, which facilitates blood flow to the hand," explained Dr. Gasperetti. "As long as the patient has this connective arch, they will respond well to transradial cath, for while radial artery is cannulated, the hand will still have adequate flow via the ulnar artery. Patients who do not have a palpable ulnar artery or exhibit a negative result on the Allen's test and/or Doppler are excluded as candidates for transradial catheterization."

Another benefit of this technique is the superficial location of the radial artery, which facilitates hemostasis and, therefore, promotes superior control of the bleeding site. Unlike the femoral artery in which bleeding complications, if any, can be difficult to monitor and/or control, bleeding at the radial entry site will be noticed immediately. This important benefit allows cardiologists and patients to address bleeding problems without delay, thus minimizing blood loss. In addition, the absence of any major veins near the radial artery makes the incidence of arteriovenous fistula rare. The median nerve is fairly isolated from the artery and is not typically damaged during puncturing or bleeding.

The procedure itself does not vary much from traditional cardiac catheterization. The laboratory, equipment and staffing are nearly identical to those used during femoral cardiac catheterization, and the procedure time is comparable as well. "You're coming at the heart from a different angle, so your technique does need to be modified a bit," said Dr. Gasperetti, who has over five years experience performing transradial catheterization. "After learning the differences of the technique and getting used to the new approach, one becomes more comfortable with it. Also, newer equipment with tiny catheters has made the procedure easier, with minimal trauma to the radial artery."

Prior to the procedure, the patient's anterior distal forearm and hand are prepped in a sterile fashion and placed in an arm board. Because the radial artery is smaller in diameter, the catheter sizes are between 5 and 7 French. Therefore, patients with very small arteries may not be good candidates. Also, 5,000 units of heparin is administered to prevent occlusion of the artery when the sheath is removed and intraarterial nitroglycerin is administered routinely to prevent spasm. Once the sheath is removed, approximately ten minutes of manual pressure is applied and then a pressure bandage is secured over the site.

"When the appropriate patient population is selected, transradial cardiac catheterization is not only a safe and effective technique, it also has the potential to lower hospital costs," said Dr. Gasperetti. "In addition, patient satisfaction is generally very high; patients really enjoy the early ambulation and faster discharge."

To learn more about transradial catheterization or for specific questions, you can e-mail Dr. Gasperetti at gasperettic@deborah.org

Christine Gasperetti, MD., Attending Cardiologist, Department of Cardiology

Imagine being unable to climb a flight of stairs, dance to a favorite song, or walk to a corner store without pain. Nearly eight million Americans cannot perform these simple activities without debilitating leg pain, and many of them assume this pain is an inevitable effect of aging. But this assumption can be a serious mistake.

Pain, numbness, and weakness in the legs with exertion are common symptoms of Peripheral Vascular Disease (PVD), a medical condition in which arteries in the legs are clogged or narrowed, and can occur as a result of arteriosclerosis or atherosclerosis. The disease can be treated by angioplasty, thrombolytic therapy, thrombectomy or bypass graft surgery, but, if left untreated, walking is difficult, ulcers may develop, and, in severe cases, gangrene can result, making amputation eventually necessary. The early detection of PVD is important in successfully controlling the disease.

To promote the early detection and treatment of PVD, Deborah Heart and Lung Center medical staff will provide free screenings for Peripheral Vascular Disease on Friday, September 22, as part of the Society of Cardiovascular and Interventional Radiology's "Legs for Life" campaign. This week-long, annual program is dedicated to improving the cardiovascular health of communities nationwide.

"Legs for Life" screenings will take place during the week of September 17-23, 2000, when participating hospitals across the United States will provide free screenings to patients and area residents. The goals of the campaign are not limited to treating patients who are diagnosed with PVD; they also include raising awareness of the disease and modifying its risk factors.

"We at Deborah Heart and Lung Center are hoping, through our involvement with the "Legs for Life" program, to raise awareness of PVD in the community," said Manu Rajachandran, MD, Medical Director, Comprehensive Vascular Program, Deborah Heart and Lung Center. "Most people are not aware of PVD, its symptoms, or its relevance as an important marker for cardiac disease and other vascular problems."

Though Peripheral Vascular Disease primarily affects men and women over the age of 50, patients can be diagnosed at any age. People experiencing leg pain while walking or numbness and coldness in the lower legs and feet are encouraged to schedule a free screening, as are people with a history of other cardiovascular ailments. According to Dr. Rajachandran, heart disease and PVD will often occur in the same population of patients, and PVD commonly acts as an early warning sign of coexistent coronary artery disease.

Patients referred to Deborah for a "Legs for Life" screening will receive an Ankle Brachial Index (ABI) test, a ratio of systolic blood pressures between the arm and the ankle, to determine the existence or absence of PVD. Those patients with a ratio less than .9 will be triaged for further tests or care, and Deborah cardiologists will counsel patients with normal ABIs on how to maintain cardiovascular health and minimize PVD risk factors.

According to Dr. Rajachandran, the Ankle Brachial Index is perhaps the easiest and most fundamental test for vascular disease and coexisting cardiac conditions, making the "Legs for Life" screenings tremendously valuable, both as a means to diagnose and treat patients with PVD and as a vital independent barometer for the existence or risk of heart disease.

"We call the program 'Legs for Life' not just because early treatment of PVD can prevent amputation," commented Dr. Rajachandran, "but also because a PVD screening can lead a cardiologist to so many diagnoses. When you screen for legs, you screen not just for legs, but for life, as well." Patients diagnosed during a "Legs for Life" screening at Deborah Heart and Lung Center will have the benefit of the combined expertise of cardiologists, radiologists, and vascular specialists and surgeons during their treatment. According to Dr. Rajachandran, because of the level of communication and teamwork that exists among Deborah's medical staff, patients are able to receive a more comprehensive level of care than if they were screened in an office setting.

"What these patients will be offered at Deborah is truly a full spectrum of treatment," said Dr. Rajachandran. "Cardiologists are able to prescribe medications to minimize symptoms and recommend lifestyle changes to minimize risk factors. Vascular specialists examine the patient's whole vascular system to minimize risk of stroke, limb loss and organ atrophy due to vascular disease. Radiologists will collaborate in the interpretation of ultrasounds and x-rays to accurately and effectively diagnose any problems," Dr. Rajachandran continued. "This level of communication and teamwork wraps the patient in a blanket of collateral benefits derived from a multidisciplinary "Legs for Life" screening."

"Legs for Life" made its national debut in 525 U.S. hospitals in September 1999, when nearly 7,000 medical professionals screened about 73,700 patients for PVD. About six percent of patients screened were found to be at high risk for PVD; another 18 percent were at moderate risk. These individuals were advised to seek further evaluation from their personal physician. More than 77,000 primary care physicians were contacted with information about PVD and the screenings and media coverage of PVD and the "Legs for Life" program reached more than 161.3 million people.

"The 1999 event informed over two million people about PVD, whether through an actual screening or through local television or newspaper coverage," said Dr. Rajachandran. "It is this type of widespread awareness that we, as a participating institution, hope to raise of PVD so that people with symptoms will understand what they may be suffering from. Physicians at Deborah Heart and Lung Center hope that patients will come see us before the disease progresses, so that we can help them walk pain-free and keep their 'Legs for Life.'"

Manu Rajachandran, MD., Medical Director, Comprehensive Vascular Program