What is a transradial heart catheterization procedure?

Transradial cardiac catheterization is a minimally invasive procedure to diagnose and treat certain cardiovascular diseases.
Transradial cardiac catheterization is a minimally invasive procedure to diagnose and treat certain cardiovascular diseases.

Transradial cardiac catheterization is a minimally invasive procedure to diagnose and treat certain cardiovascular diseases. A thin, flexible tube (catheter) is inserted through the radial artery in the hand and into the heart and its blood vessels. Ultrasound scanning and continuous X-ray (fluoroscopy) are used for guidance during the procedure.

Traditionally, the primary route for cardiac catheterization has been the femoral vein in the groin (transfemoral). The catheters used in the earlier days were larger and needed a large blood vessel to go through. Advancement in technology has made transradial catheterization possible with thinner catheters that can go through smaller blood vessels.

Advantages of transradial approach over transfemoral

  • Improved patient comfort, since patients don’t have to lie flat for a long period after the procedure, as is the case with transfemoral approach.
  • Less expensive and shorter hospital stay.
  • Lower risk for
    • Bleeding at the catheter entry site, because the radial artery is small and superficial, and bleeding can be easily controlled with gentle pressure.
    • Hematoma and blood collecting inside the layers of the vascular wall (pseudoaneurysm).
  • No risk of bleeding in the abdominal cavity (retroperitoneal hemorrhage).
  • Beneficial for patients who
    • are elderly
    • have back problems and find it difficult to lie flat
    • have acute coronary syndrome and are on anti-platelet therapy to prevent blood clotting
    • have a major coronary artery blockage (ST-elevated myocardial infarction)

Disadvantages of transradial approach

  • Technically more challenging and requires a high level of expertise to negotiate the loops in the radial artery and aortic arch.
  • Increased procedural time resulting in increased radiation exposure from fluoroscopy. (The procedural time reduces with experience level of the surgeon).

What is a cardiac catheterization done for?

A transradial cardiac catheterization may be performed for diagnostic or therapeutic purposes.

Diagnostic

  • Location of narrowing (stenosis), or blocks in the coronary blood vessels (angiogram)
  • Evaluation of the condition and functioning of heart valves
  • Detection of congenital heart defects
  • Measurement of pressure and oxygen levels in the heart (hemodynamic assessment)
  • Assessment of the heart’s pumping function (ventriculogram)
  • Extraction of tissue sample for biopsy

Therapeutic

  • Dilations of stenosed blood vessels and removing blocks (angioplasty)
  • Placement of stent in the coronary arteries
  • Correction of congenital defects
  • Dilation of narrowed heart valves (balloon valvuloplasty)
  • Repair and replacement of heart valves
  • Treatment of irregular heartbeat with cardiac ablation (scarring heart tissue to stop abnormal electrical impulses)
  • Closing off a part of the heart’s atrium (left atrial appendage) to prevent formation of clots in people who are at high risk for clots

A transradial approach is avoided

  • If the patient’s radial artery is too small to insert the catheter
  • If transradial access is blocked for any reason
  • In hemodialysis patients, in the hand in which they have a shunt for dialysis

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Medically Reviewed on 5/8/2020
References
Medscape Medical Reference
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