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Healing the heart through the wrist
The Tribune 13thDecember, 2006

Kissing balloon technique for performing angioplasty, on a blockage at a point on the coronary artery where it divides into two, uses a single guiding catheter to guide two ultra-thin wires with balloons that are then inflated simultaneously using two inflation devices. In simpler terms, this approach amounts to performing two angioplasties simultaneously, using single guiding catheter through single vascular access.

Till now such complex angioplasties were rarely performed using the transradial approach. But today more and more patients are preferring transradial access for coronary procedures over the conventional transfemerol approach, and complex angioplasties, as above, are possible through the radial technique.

Angiographies are, in today's fast-paced and stress-laden lives, a quick and safe means of deciphering if your heart is in order and functioning to its optimum. Often angiographies show obstructions in arteries that are almost simultaneously treated by angioplasties, which, in a layman's words, is ballooning and stenting of the artery so that the obstruction is removed.

The myth that angiographies and angioplasties are "dangerous" should be completely destroyed now, with the advancement in expertise and technology. Only one of 1000 persons suffers a complication during an angiography and one in 100 during an angioplasty, which would be the ratio in any other invasive procedure too. The message is that do not hesitate in getting an angiography done, but yes, do not compromise on the quality of medical expertise or facility that you opt for!

For a long time, coronary angiography and angioplasty procedures have been performed through the thigh (transfemoral approach). Today, transradial access for coronary procedures is preferred by patients, and complex angioplasties are being performed through the radial approach.

Some of the significant advantages of the transradial approach over the conventional approach (via a thigh artery) are:

• Although more difficult for the interventionalist to perform, it is pertinent to note that this new approach is complication-free and very comfortable for the patient.
• The transradial approach allows the patient to be mobile immediately after the procedure while in the conventional approach the patient has to lie down flat on the bed for a least six-eight hours post-procedure.
• The conventional approach is associated with several problems due to prolonged imobilisation. These are
• Backache
• Urinary retention
• Patients of bronchial asthma and heart failure find it extremely uncomfortable to lie in bed for extended durations.

All these conditions are virtually absent in the transradial approach.

• Femoral artery used as the access site in the conventional angiography/ angioplasty lies deep and is not easily compressible. Therefore, the chances for major hematoma requiring blood transfusions and residual femoral artery defects requiring surgical correction are as high as 2-8 per cent in the transfemoral approach. These complications are nearly nil in transradial procedures.
• Thigh vein and nerve that accompany the thigh artery, which is the access site in the conventional procedure, are liable for damage in conventional angioplasties. But the risk and complications of damage to these is virtually absent in the transradial approach.

Transradial interventions have fewer complications, but are technically more difficult to perform. The lavel of complexity for the surgeon makes the procedure exceptional and rare.

This relatively new technique promises lower morbidity and improves patient satisfaction. Among patients undergoing diagnostic cardiac catheterisation, transradial access leads to improved quality of life after the procedure. It is strongly preferred by patients and it reduces hospital costs.

The writer is a Senior Consultant in Cardiology at Fortis Healthcare, Mohali.