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A New Approach to Cardiac Catheterization

Published in Health Matters, Summer 2010

Cardiac catheterization is a valuable tool for physicians who look for heart disease and treat heart problems such as narrowed arteries. But for the patient, it's traditionally involved a pretty tedious recovery: lying flat for several hours to prevent bleeding after the procedure. Not anymore.

A newer catheterization technique being performed at Augusta Health is increasing patient comfort and lessening the risk of post-procedure complications.

A new way in

A traditional cardiac catheterization involves inserting a long tube called a catheter into a groin artery and threading it through blood vessels up to the heart. Rajeev Pillai, M.D., an interventional cardiologist with Augusta Health, prefers to take a different route.

Dr. Pillai trained at India's prestigious Sree Chitra Tirunal Institute for Medical Sciences & Technology and continued his medical training in the United States at the State University of New York at Buffalo and Newark Beth Israel Medical Center in Newark, N.J.

About 3 percent of cardiac catheterizations in this country are performed using what's called a radial access approach. Dr. Pillai inserts the catheter in the radial artery in the right wrist, then threads it up to the heart.

"The advantages include minimal bleeding—if any—and patients don't have to lie down for long periods after the procedure," Dr. Pillai says. With traditional cardiac catheterizations, patients lie flat for as long as six hours to allow the deep-lying groin artery to heal, he says. Not doing so could lead to serious bleeding—the most common complication of the procedure. But using the radial artery (which lies closer to the surface and is easier to access) eliminates that step, and patients can sit upright and move around immediately, he says.

So why aren't more cardiac catheterizations performed this way? Dr. Pillai, who uses it in about 50 percent of his cases, says the technique is more technically difficult for the physician. Physicians also have to be quick, he says, as taking too long can send the radial artery into a spasm and close it off.

In addition, not everyone is a candidate. Because radial access can take a little longer to perform, it's not the best option for emergency cases such as heart attacks. And because of anatomy issues and some problems with the strength or health of the arteries, it's not typically used on patients who are very thin with smaller arteries, those who've had multiple bypass grafts or those with longstanding high blood pressure. "We also don't typically use this method for patients older than age 70," Dr. Pillai says.

While radial access is not yet in widespread use in this country, right now you can find this advanced treatment here at Augusta Health.

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