Getting to the heart through the wrist

The devel­op­ment of non-surgical pro­ce­dures over the past 20 years has been one of our most remark­able advances in the treat­ment of heart disease.

Instead of open­ing the chest and spread­ing the rib cage, we increas­ingly have been able to deliver med­i­cines and devices to the heart through soft, flex­i­ble tubes — called catheters — inserted through small nee­dle punc­tures in the skin and guided through the arteries.

These catheter-based meth­ods allow us to avoid the pain, scar­ring and long recov­ery from open-heart surgery. They may be used for diag­nos­tic pur­poses to detect heart dis­ease, and for treat­ment pur­poses to open blocked arter­ies and keep them open with devices such as bal­loons and stents.

Typ­i­cally, we have inserted these tubes through an artery in the leg, but advances in catheter design have made it eas­ier to enter the body through an artery in the wrist. Entry through the wrist reduces the risk of bleed­ing, increases patient com­fort and speeds recovery.

After entry through the leg, patients must lie flat for up to six hours to pre­vent exces­sive bleed­ing. After entry through the wrist, we sim­ply con­trol bleed­ing with a pres­sure band on the wrist. Patients are able to get out of bed, walk around and go home sooner. Entry through the wrist often is less com­pli­cated in obese patients whose fatty tis­sue makes it dif­fi­cult to access the leg artery.

While pro­ce­dures through the artery in the wrist have been the pre­ferred method in many coun­tries for many years, they are gain­ing wider clin­i­cal accep­tance in the United States due to the advan­tages we’ve mentioned.

To deter­mine if you are a can­di­date to have a catheter inserted through your wrist, we test to make sure the arter­ies in your hand are open and healthy. Some devices that need to be used, or med­ical con­di­tions, may require entry through the artery in the leg. The risks and ben­e­fits of the two approaches vary accord­ing to the indi­vid­ual and should be dis­cussed with your cardiologist.

Grady Memo­r­ial Hos­pi­tal patients may be can­di­dates for catheter-based pro­ce­dures includ­ing radial access angio­plasty to diag­nose many heart prob­lems. If more advanced treat­ment is needed, Grady patients can make a smooth tran­si­tion to one of our Ohio­Health part­ners in Colum­bus, Grant Med­ical Cen­ter and River­side Methodist Hos­pi­tal. The heart and vas­cu­lar physi­cians who see patients and per­form heart ser­vices at Grady also prac­tice at Grant and River­side, allow­ing them to fol­low patients through every step of treatment.

Dr. Tejas A. Mehta is a board cer­ti­fied inter­ven­tional car­di­ol­o­gist with Heart­Care and an active mem­ber of the Grady Memo­r­ial Hos­pi­tal Staff.

Posted by Grady Memorial Hospital on Feb 23 2012. You can follow any responses to this entry through the RSS Feed. Comments can be made below.