New cardiac catheterization procedure could reduce recovery time
By Judy Kroeger
Published: Friday, May 13, 2011
Patients who require cardiac catheterization now have a more comfortable option for the procedure. More doctors have begun accessing the heart through a wrist artery rather than a leg artery, reducing recovery time pain.
"I'm really excited. I think patients would love it, too. There's patient acceptance, comfort, less bleeding and a shorter recovery time," said Dr. Krishna Tummalapalli, who offers patients a choice of catheterization through the wrist's radial artery or the femoral artery in the groin.
Tummalapalli, twice certified in interventional cardiology, has performed more than 10,000 coronary and vascular procedures in his 25-year career. Currently, he performs about half of his catheterizations transradially.
Tummalapalli performs the procedures at Shadyside or Mercy hospitals in Pittsburgh, but he and his colleagues in the Pittsburgh Heart Group examine Fayette area patients in their Highlands Hospital office.
In addition to Tummalapalli, doctors Kenneth Vesio, John Ward and B.V. Rao comprise the group, which has been in Connellsville for 15 years.
Insurance companies pay for the alternate site.
"Insurance companies make no differentiation. To the insurance company all it means is cardiac catheterization," he said.
Three conditions indicate the need for a heart catheterization: an abnormal stress test, angina or chest pains or a heart attack.
The catheterization is a detailed diagnostic tool. It will indicate the extent of the coronary disease, the blockages. Three major coronary arteries supply the left ventricle of the heart. A 70 percent or more blockage can cause angina. The doctor will put in a stent during the procedure. A blockage of 70 percent or less will be treated medically. If all three vessels are blocked, doctors recommend coronary bypass surgery.
Following an abnormal stress test, Tummalapalli will see the patient in his office. "I tell them there are two approaches, the traditional approach through the groin or the radial approach. In other countries, up to 80 percent are done transradially. Here, just 10 percent."
He believes that as word of the increased comfort and decreased complications spreads, patients will ask their doctors for the radial procedure.
Groin complications include bleeding, both external and internal, into the pelvis.
"When we do the catheterization from the femoral artery, some doctors put a collagen plug. Those patients have to lay flat for two to four hours. Without that, they have to lay flat for six hours.
A sandbag weights the wound to prevent bleeding. Patients require IV narcotics. They have to use a bedpan or have a Foley catheter during recovery. "Big people, those with COPD, back pain, those are the types of people who benefit most from radial," Tummalapalli said.
Women, too, benefit. Although they have smaller arteries than men, they tend to have more bleeding after femoral catheterization because men have more muscle tissue that can help hold the artery closed after the procedure. Studies have shown that overall, the transradial approach cuts down on the need for post-procedure blood transfusions by 50 percent.
The transradial approach requires an Allen test to determine that the ulnar artery will provide blood to the wrist during the procedure. Tummalapalli performs the test himself before beginning.
The patient receives IV sedation and medicines to prevent arterial spasm. A local anesthesia numbs the site. The needle and guide wire are inserted; the needle is removed and the catheter inserted. Fluoroscopic dye allows the doctor to see blockages. The doctor follows the radial artery over the shoulder, the auxiliary and innominate arteries into the ascending aorta to obtain pictures of the left coronary arteries. A pressure band, consisting of a balloon on a wrist band, is placed.
The procedure lasts about an hour, with the catheterization itself taking about 15 minutes.
The patient returns to the observation area, is watched for two to four hours and goes home. He or she can move around during recovery.
Tummalapalli said the transradial approach "is not a major hardship, but there is an initial learning curve for the doctor." He said physician inertia explains this procedure not being as popular here as abroad.
"I have had a couple of patients who had heart catheterization done through the groin and had it from the wrist and absolutely loved it. They are the greatest advocates."
Don Whittaker, 59, of South Connellsville, has had both types of catheterization. He works as a school policeman at Junior High East.
He said coronary artery disease runs in his family.
His first procedure occurred three years ago.
"Dr. Tummalapalli did it," Whittaker said. "I didn't need stents or surgery. He put me on medication. I stayed overnight. I was completely black and blue from the top of my leg to my knee. I laid still for six hours with a sandbag on my leg."
In January, Whittaker had a stress test that indicated problems. He had the transradial procedure. "They took me in and prepped me for both ways, in the leg or the wrist. By the time Dr. Tummalapalli got in, I was completely out."
The second procedure differed. "The one in the wrist was easy, nice," Whittaker said. "I never got black and blue. I had two little dots. I came home that same day. There wasn't a lot of pain either."
The transradial catheterization indicated major coronary blockage.
"I had a quadruple bypass on Jan. 10," Whittaker said. "I went back to work on March 1."
When asked about the transradial procedure, Whittaker said, "I would recommend it. The Pittsburgh Heart Group is a very good group of doctors. I see them at Highlands, then have the procedures at Shadyside. It's good they come here. Talking about this, that's the least I could do."
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