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New Directions

Issue: Summer

Way to Go! Radial Artery Catheterization

After having radial artery catheterization, patients Ronald Burner, left, and James Feldman celebrate with a high-five. They experienced a swift recovery and very little discomfort.

Ask James Feldman of Rockville and Ronald Burner of Damascus to describe their angioplasty procedures at Suburban Hospital and they’ll both raise their hands.

That’s because the stents that were placed in their heart vessels were accessed through the radial artery in their wrists, instead of the more traditional femoral artery route in the groin.

As improvements in technology have made the procedure easier and safer, more physicians have become trained to use the radial artery approach, according to Greg Kumkumian, M.D., medical director of Suburban Hospital’s coronary care unit, who performed the interventions on both Mr. Feldman and Mr. Burner.

The procedure continues to gain popularity among cardiologists and patients, alike, and it’s easy to see why. For most patients, radial artery access causes less discomfort and allows them to get out of bed, eat, and walk around almost immediately after the procedure. In contrast, when the procedure is done by accessing the artery in the groin, patients need to lie flat in bed for 4 to 6 hours to allow the vessel to heal. In addition, the radial artery approach is associated with less bleeding and fewer vascular complications.

While many cardiologists still prefer to prep the groin area in case clinical indicators require a change mid-procedure, Dr. Kumkumian has not found this to be necessary. “Out of about 200 procedures, I’ve only encountered a couple where we needed to go back to the groin,” he explains, “and in those cases, it only took us a few minutes to make the course correction.”

To be a candidate for the radial approach, patients must have good blood supply to their hand through both vessels in the wrist. This is important to assure normal flow to the hand during and after the procedure. That’s why, at Suburban Hospital, interventional cardiologists Yuri Deychak and Greg Kumkumian (who practice with Johns Hopkins Community Physicians Heart Care) first perform the simple “Allen test” to ensure that both the radial and ulnar arteries in the wrist are working.

The Allen test involves pressing down on both arteries simultaneously before releasing flow from the ulnar artery and observing for a good return of blood circulation to the hand. Fortunately, the majority of patients have a normal Allen test and are therefore candidates for the radial approach.

Prior to the radial artery procedure, the patient receives light sedation and a local anesthetic. The cardiologist threads a thin catheter through the body’s network of arteries in the arm and into the chest, eventually reaching the heart. At that point, a balloon on the end of the catheter can be used to open the blocked arteries, and a stent (a small, mesh-like device) may be placed in the vessels to help ensure they stay open.

James Feldman and Ronald Burner had the opportunity to compare the femoral artery and the radial artery approaches to angioplasty because they have each experienced both procedures. “I’ve had worse experiences in a dental chair,” says Feldman. “Recovery through the wrist is so much easier; there’s little discomfort, and two days later, it’s like it never happened.”

Ronald Burner concurs: “Having gone through both procedures, there is no way in the world I would choose to undergo the femoral artery process again if I didn’t have to,” he notes.

Both men are well on the road to recovery and looking forward to a summer of gardening, travel, deep sea fishing, and enjoying time with their grandchildren —­ a total of 14 between them!



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