New cardiac procedure may reduce complications and hospital costs

Jan 7 2010

A new approach to common cardiac procedures called transradial angiography might lead to reduced patient complications and recovery time and decreased hospital costs.

Cardiologists at the University of Illinois and Jesse Brown VA medical centers are among the first in the Chicago area to offer the approach to heart angiograms and clearing blocked arteries.

In the procedure, a catheter is threaded through the small radial artery in the wrist rather than the larger femoral artery in the groin.

"It's a simple change that has a dramatic impact on the experience and recovery of the patient," said Dr. Adhir Shroff, assistant professor of cardiology at UIC.

Although complications from standard catheterization through the groin are low, occurring in only 2 percent to 9 percent of patients, the transradial approach can reduce bleeding -- the most common complication, particularly among women and the elderly -- to under 1 percent. It also eliminates much of the discomfort associated with the procedure.

Following a standard angiogram and angioplasty through the femoral artery, the patient needs to lie still on his or her back for four to six hours. This can be very uncomfortable for elderly patients with back problems, Shroff said. Walking can be uncomfortable for days.

In contrast, patients who have the procedure done via the wrist can immediately sit up, eat, and walk without pain, said Shroff.

The transradial procedure has been widely adopted in Europe, where up to 60 percent of procedures are now done this way. In the U.S., only about 2 percent of coronary interventions use the procedure.

"The issue is really just the learning-curve," said Shroff. "The change requires dozens of small changes -- everything from redesigning the sterile drape so that the openings are at the wrist rather than the leg and finding smaller needles, wires and catheters to the way the table is set up."

Last month, Shroff, Dr. Mladen Vidovich, UIC assistant professor of cardiology, and Bernadette Speiser, nurse manager in cardiology at the Jesse Brown VA Medical Center, led an all-day workshop at UIC in implementing a transradial approach that drew cardiologists and other catheter lab team members from the Chicago area and around the country. The Jesse Brown VA Medical Center is one of only a handful of VA centers in the country to offer the procedure.

"We've solved dozens of small problems that stand in the way of implementing this kind of program, so that everyone interested in transradial cardiac catheterization doesn't have to re-invent the wheel," said Speiser.

In addition to offering a ready-made approach to the technique, Shroff said the key is enlisting the help and cooperation of everyone involved in the cath lab, from nurses and nurse-managers to the technicians who set up the equipment.

Schroff says there is no downside to using the transradial approach where appropriate.

"And in these times, as everyone tries to think strategically about the delivery of healthcare, the savings in terms of costs and hospital resources offered by transradial catheterization make it especially attractive," he said. "It is my belief that once a patient has their procedure done from the wrist, they will demand that approach in the future, if they require it again.".

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