Catheterization through the Arm Offers Alternative to Groin Approach

For years, cardiac surgeon Laxman Kamath, M.D., used his skills to operate on patients with coronary artery disease. Then, in 1999, he needed the same type of help he was used to giving to others.

He was diagnosed with two blockages in his right coronary artery and minimal narrowing in his left anterior coronary artery system. He underwent a balloon angioplasty with insertion of a stent to relieve the blockage in one of his critically-narrowed right coronary arteries. A balloon angioplasty is a procedure that widens the obstructed blood vessel, and the insertion of a stent keeps the blockage open for a longer period of time. Like most cardiac patients, he received heart catheterization a procedure where physicians insert a catheter through an opening in an artery. The most common way to complete the procedure is through the femoral artery, located in the groin.

Dr. Kamath retired to Southwest Florida and did not experience any more heart issues until earlier this year, when he had nonspecific abdominal pain, sweating and nausea. He experienced the symptoms twice in three weeks, each lasting approximately 5-10 minutes. After checking his blood pressure, which was within normal limits, he resumed his daily activities.

Approximately three weeks later, a third episode lasted for almost 30 minutes. This time when he checked his blood pressure, it was low and his heart rate was higher than normal.

He called his internist, Brito M.R. Chinnappan, M.D., and requested an electrocardiogram. The test showed he had experienced an inferior wall (bottom of the heart) heart attack. Dr. Chinnappan sent me straight to the hospital ER from his office, through EMS services, Dr. Kamath says. That s where I met Dr. Pal (cardiologist Subhash Kshetrapal, M.D.). He performed cardiac catheterization, discovered that my old stent was still open, but the second narrowing in the right coronary artery, which had previously indicated minor narrowing in the left anterior descending arteries, had become more critical.

Dr. Pal needed to do a catheterization, but this time he told Dr. Kamath he would use a much newer procedure, radial catheterization, which uses an artery in the wrist instead of the groin to access the heart. At first I didn t know what to think of it, but once I had the procedure, I realized it was one of the best things he did, Dr. Kamath says. My recovery time was much shorter with the radial artery approach.

Because the procedure is in the arm, patients do not have to remain immobile, with a threat of blood clots that could travel to other parts of the body. It s a much safer procedure, Dr. Pal says. I ve been doing it for about four years and find it s much more convenient for the patient.

Dr. Pal offers his patients a choice, but once he explains the difference in the two procedures, most choose the radial approach. It s a more appealing option, he says. It eliminates problems for people who have back issues, people who are overweight and those who have bad circulation.

Radial catheterization also eliminates the risk of blood collecting in the tissues around the artery, known as a hematoma. Very rarely, a patient having this procedure through the groin can experience bleeding in the back of the stomach retro-peritoneal hematoma which has the potential to develop into a serious complication. If there is bleeding during a radial catheterization procedure, Dr. Pal can control it by applying pressure.

Another possible complication of catheterization via the groin is pseudo aneurysm, where the artery does not close after the procedure, and a vascular surgeon must repair the artery. Radial catheterization helps avoid this risk.

The radial artery is a very superficial artery, and it can be compressed easily, Dr. Pal says. The patients love it, too, because they get to go home sooner, sometimes the same day they receive the stent.

Dr. Pal says he expects more physicians to offer the radial procedure in the future. It s been evolving in the past couple of years, he says. Other doctors are taking the training and learning the procedure. Ultimately, it s safer and the patients love it.


Looking into your Heart - Catheterization


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Subhash Kshetrapal (Dr. Pal), M.D.
Lee Physician Group
16261 Bass Road*
Suite 300
Fort Myers, FL 33908

* An outpatient department of Lee Memorial Hospital.



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