HealthFirst reporter Leslie Toldo shows us how going through the wrist instead of the leg is making angioplasty better.
The wrist is not only closer to the heart, it may be the better route to recovery for patients.
Robert Santopietro looks and feels like a healthy 46 year old. "I started working out, getting back into shape - New Year's resolution."
So when he ran out of breath and felt chest pains during workouts, he brushed it off. "I just put it off to I ate before I went to go work out."
The pain persisted. Santopietro had atherosclerosis. Plaque was building up in his arteries.
"That plaque may become restrictive enough that there's inadequate flow, or more emergently, some degree of clot may form," explained Dr. Michael Azrin.
Santopietro needed an angioplasty to unclog his arteries. Instead of the traditional technique where doctors reach the heart by inserting a catheter through the femoral artery in the leg, he had a wrist angioplasty where doctors thread a tiny balloon through the catheter and guide it into the blockage.
In a leg angioplasty, there's an up to 10 percent risk of heavy bleeding. One study shows the wrist procedure cuts that risk by 60 percent.
"When you're done, you pull the tube out and put a bandage on the wrist, and the patients can sit up. They can walk around. They can return to normal function very quickly," Azrin said.
Santopietro's stepfather, Dan, had the procedure done less than a week ago. "Before, I'd get halfway up the stairs and have to stop, and now I can go all the way."
Santopietro also notices a difference. "I feel 100 percent better. Knowing what could have happened and didn't happen is just amazing.">
Another benefit of wrist angioplasty is unlike angioplasty through the leg, patients who have a wrist angioplasty don't have to lie flat on their backs for several hours afterward.
BACKGROUND: Coronary angioplasty is a procedure used to open blocked or narrowed coronary heart arteries. This procedure is more commonly used in a heart attack situation. The procedure improves blood flow to the heart muscle. Angioplasty is done on more than 1 million people a year in the United States. Serious complications don't occur often. However, they can happen. The usual route to perform this procedure is to thread a tube to the heart through an artery in the groin.
COMMON PROCEDURE: Angioplasty physically opens the channel of diseased arterial segments and relieves the recurrence of chest pain. Since it is performed through a little needle hole in the groin, or sometimes the arm, it is much less invasive than surgery and can be repeated more often should the patient develop disease in the same, or another, artery in the future. Cardiologists have preferred working through the femoral artery in the groin because it's a larger blood vessel and easier to tug catheters through. When the procedure is over, heavy pressure is applied until the puncture site quits bleeding and essentially heals itself. Heavy bleeding and related complications are a risk, happening anywhere from 2 percent to sometimes as many as 10 percent of patients.
Over the past year, the transradial approach, or the wrist approach, has gotten significant attention. Studies show that angioplasties performed through the wrist instead of the heart were equally effective at clearing heart arteries. Nearly 2 percent of patients treated the usual way bled compared with slightly less than 1 percent of those treated via the wrist. The reason cardiologists prefer the usual approach comes to training and interest. Doctors have the perception that certain complex interventional procedures are more difficult through the wrist, but studies show that the wrist approach could be safer because the puncture site can be bandaged. The wrist method cuts the bleeding risk by 60-percent. "The procedure is not one that should be recommended for everybody," Dr. Sidney Smith, from the University of North Carolina at Chapel Hill, was quoted as saying. "But there are definitely groups of patients where this can be done with same results and fewer complications."
FOR MORE INFORMATION:
Carolyn Pennington
Office of Communications
University of Connecticut Health Center
Farmington, CT
(860) 679-4864
cpennington@uchc.edu
