Doctors use a small artery in the hand to diagnose coronary disease

“Small” is everywhere — small computers, pocket-sized phones and even hand-held televisions.

Now, thanks to today’s state-of-the-art cardiac devices, doctors at UW Hospital and Clinics have begun using a small artery in the wrist to diagnose and treat some forms of coronary artery disease.

The procedure, called radial artery catheterization, is just as safe as traditional catheterization through the leg, but enables people to be up and around about three times more quickly.

“Most patients vastly prefer the wrist approach,” says Matthew Wolff, an interventional cardiologist at UW Hospital and Clinics. “From our perspective, it’s easy and safe, and not much different from doing it through the leg.”

Cardiac catheterization is a procedure which, among other things, reveals the location and severity of coronary blockages. Though it can be done through the arm, the standard approach for the past 25 years has been to insert a long, flexible tube, called a catheter, in the leg’s femoral artery. The catheter is then guided into the heart and coronary arteries, where doctors inject an X-ray dye through the catheter to reveal the nature and extent of the blockages.

While leg catheterization is safe and reliable, the downside is that patients must lie flat in bed after the catheter is removed to give the artery time to heal and reduce the risk of bleeding. This usually takes six hours, longer if doctors immediately open the blocked arteries with such procedures as angioplasty or coronary stenting.

With radial artery catheterization, patients can be up and around in an hour or two. That’s because doctors use the radial artery, located at the base of the thumb, to perform the catheterization. The artery is so small that it can be compressed with a bandage after the procedure.

“Many patients, in fact most patients, tell us that the most uncomfortable part of the whole catheterization is having to lie flat in bed for a long period of time,” says Richard Stewart, an interventional cardiologist who, along with Wolff, performs radial artery catheterizations at UW Hospital and Clinics. “With radial artery catheterization, the inconvenience for the patient is minimal, and we expect to begin sending some of them home the same day.”

Performed under local anesthesia, radial artery catheterization is the result of new, smaller catheters which can fit into the radial artery and which offer a pathway to the heart. In addition, coronary stents, which keep the arteries open after angioplasty, are now about as thin as a coat hanger and can be guided into the heart through smaller catheters.

Wolff and Stewart say radial artery catheterization, which is becoming increasingly popular around the country, is an option for about 90 percent of patients who need catheterizations. The remaining 10 percent do not have adequate blood flow to the wrist but remain candidates for leg or arm catheterizations. UW Hospital and Clinics is one of the few institutions in the area that offers all three options.