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  • Angioplasty through wrist: Saves more lives as well as cost

    Published on February 24, 2014

    New Delhi: When Dutch cardiologist Dr. Ferdinand Kiemeneij first conducted a minimally invasive heart intervention through the wrist in 1992, it was believed that the approach would be needed only in some patients on whom the traditional groin approach was not feasible. However, over the past few years this method is increasingly finding favor with cardiologists and all kinds of patients for being safer and more convenient.

    Dr.Tapan Ghosh-1Minimally invasive techniques as they are called, reduce recovery time and risk of something going wrong and wrist angioplasty is among the latest improvements made in the field. Angioplasty is a minimally invasive technique that is used to diagnose and unclog blocked or narrowed arteries. Catheters or stents are inserted through arteries into the body to open up the obstructed artery and resume the blood flow.

    Wrist angioplasty, also called the trans-radial approach allows a cardiologist access to a patient’s heart through the artery in the wrist unlike the more traditional femoral approach which requires a catheter to be inserted into the heart via the femoral artery in a patient’s groin.

    Dr Tapan Ghose, Director & HOD Interventional Cardiology at Paras Hospitals, Gurgaon, advocates for this approach as it cuts chances of complications and saves more lives.

    “Wrist angioplasty definitely saves more lives as it reduces chances of complications in patients, reduces bleeding and lessens recovery time. For patients it is radically more comfortable and lets them get on their feet rather quickly. It reduces chances of access site bleeding or hematoma. Our analysis is that it has lower complication rates than the traditional groin incision approach. And doctors today are realizing this,” says Dr Ghose who is among the pioneers of the trans radial approach in India.

    The procedure was initially thought to be useful for patients with weaker lower limbs that made them unsuitable for the traditional femoral approach. However, more and more cardiologists today are converting to this approach.

    Recently researchers at the University of Pennsylvania, the University of Washington Medical Center, and the University of Pittsburgh School of Medicine conducted a cost benefit analysis to conclude that the radial artery approach resulted in less vascular complications and significant cost-savings as against the femoral artery catheter access. In acute heart attack angioplasty through the wrist saves more lives as compared to the groin route.

    In Europe, Canada and even Japan, a large number of cardiologists today are preferring radial artery access approach. However, in other countries, including India, angioplasty through wrist is still not very common. In India, approximately 30% per cent of the total angioplasty procedures are done through the wrist.

    Lack of trained professionals in this approach is perhaps one of the reasons.

    “There are relatively lesser number of interventional cardiologists trained in the radial approach. Majority of the training institutes do not have structured training programme in this approach of angioplasty. We need to have a structured training programme on this,” highlights Dr Tapan Ghose.

    Cardiologists have traditionally preferred the femoral approach as the artery in the groin is a larger blood vessel as compared to the artery in the wrist. This makes it easier to insert catheters.

    “This was true right till some years back. But, with smaller and more flexible catheters being developed now, this difficulty has been resolved. It makes it equally easy to insert catheters through the wrist,” says Dr Ghose.

    “We have certainly come a long way from the days of open heart surgery. Medical Science over the years has made such radical progress that it is no longer required to make big holes in the groin arteries to conduct every procedure of the heart,” said Dr Tapan Ghose.