The term ‘Angiography’ embodies a feeling of apprehension and fear. Most people will avoid an angiography not because of the possible diagnosis but also because of the complicated surgical procedure it entails. However, medical advancement in the field of Intervnetional Cardiology has helped developed an easier, less complicated and faster procedure to make angiographies less stressful. Dr. Anjan Siotia, Interventional Cardiologits at BM Birla Heart Research Centre, part of CK Birla Hospitals, discussed the advantages of Radial Angiography versus the traditional Femoral method.
• How is the Radial Angiography procedure different from the traditional Femoral Angiography procedure?
Angiographies are used to diagnose the narrowing or blockage of arteries to ascertain cardiac problems in the patient. Small tubes (catheters) are inserted into the circulatory system under x-ray guidance in order to obtain information about blood flow and pressure within the heart and determine if there are obstructions within the blood vessels feeding the heart muscle. In the traditional Femoral method, an incision is made in the groin area and a catheter is inserted in the artery of the leg. From the leg, the catheter is guided to the femoral artery. A contrast medium is then injected into the blood stream so that the artery is clearly seen on an X-ray image. In Radial Angiography, the catheter is inserted from the radial artery which is located at the wrist.
• What are the advantages of opting for a Radial Angiography?
Radial Angiographies are becoming the preferred method of diagnosis due to the level of ease and comfort it provides to the patient. In the traditional method patients, would typically need to be admitted. For the post procedure, they would have to lie flat without bending the leg for 2 to 6 hours to allow the artery to heal. In some cases, even with prolonged immobility, internal bleeding could occur and could be severe enough to require blood transfusions or surgery to repair the femoral artery.
These complications can be avoided if the catheter is inserted through the radial artery. The radial artery is smaller and located closer to the surface of the skin, therefore, internal bleeding is eliminated and any external bleeding can be easily compressed. After the images of the artery are obtained the catheter is removed and a compressions device is used to contain the incision. In the case of the radial angiographies there is no requirement to be immobile and patients can go back to their day to day activity almost immediately.
In general, patients find radial catheterization more comfortable than femoral catheterization because they are able to sit up, walk, and eat immediately. This is a particular advantage for patients with back problems because there is no need for heavy pressure on the leg and prolonged immobility. This also ensures economic advantages for the patient as hospital costs are eliminated as the procedure takes only a few hours.
• Why has the traditional method been used for so long?
The biggest factor driving the decision to use the radial artery is the physician performing the procedure. The procedure can be more challenging technically, and the physician must have enough experience to feel comfortable with radial procedures. Therefore, hospitals such as the BM Birla Heart Research Centres have dedicated Radial Angiography Suites that have the infrastructure and highly skilled Interventionists.
Additionally, the downside of radial angiography is that not everyone is suitable for it. If the radial pulse is weak then the procedure cannot be done radially. Sometimes, even with a good radial pulse, the artery can go into spasm necessitating a switch over to femoral access.
• How often do you recommend Radial Angiographies?
Because of the level of comfort, it ensures for my patients I recommend and perform Radial Angiographies for almost 90% of my patients. This is a less stressful procedure and patients can come in the morning and leave in a few hours or so. Most studies comparing the two procedures have shown higher patient satisfaction in the radial angiography method.