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Wrist Angioplasty
A Patient's Guide to Frequently Asked Questions

Wrist angioplasty, also called the radial or transradial approach, is a minimally invasive cardiology technique that lets a doctor access a patient's heart through the wrist. For diagnostic heart procedures and treatments (like catheterization, balloon angioplasty and stenting), the doctor has traditionally threaded a catheter into the heart via the femoral artery in a patient's groin. However, cardiologists are increasingly introducing catheters through the radial artery in the wrist instead.
    Radial Artery
Radial Artery

These FAQs about wrist angioplasty cover the basics. We've collected firsthand quotes from top doctors in the field and from patients who've had wrist approach procedures, and we've pulled facts from recent studies and clinical trials, to help you be an educated and active participant in your own medical care.

1. How Is Wrist Angioplasty Different?
2. Is Wrist Angioplasty Right For Me?
3. How Will It Feel To Get A Wrist Angioplasty?
4. What If I'm Having A Problem After My Procedure?
5. What About Financial Cost?
6. Why Doesn't My Doctor Do Wrist Angioplasty?
7. Where Can I Find A Doctor Who Does This Procedure?
8. Where Can I Learn More About Wrist Angioplasty?


1. How Is Wrist Angioplasty Different?

From a patient perspective, the shorter, more comfortable recovery time is probably the major difference between a wrist angioplasty and the femoral angioplasty experience.

Here's a doctor's perspective on radial recovery:

"What we've noticed from a qualitative standpoint is that patients actually seem to really like it. We've actually noticed in the last two years a dramatic increase in the number of veteran patients who come to us asking for the radial approach. I think these patients talk to each other in the waiting room. And they hear from other veterans and other patients how comfortable this was and how easy it was to go through PCI with the radial approach: they're able to get up, they're able to eat right away, they didn’t have to lie in bed -- so we've seen a dramatic increase in patients coming in and asking for it." -- Dr. Sunil V. Rao, Director of the Cardiac Cath Lab at the Durham VA Medical Center in North Carolina

Many patients in our Forum echo this preference, like Bob from Seattle:

"Since June 26th I've had a radial angiogram, femoral angioplasty (2 stents) and most recently angioplasty performed right radial. There is no question that the radial approach was a more pleasant outcome." -- Bob, Seattle, Washington, USA, August 15, 2011 in our Transradial Patient Forum

Getting patients back on their feet quickly isn't the only reason why a growing number of physicians are choosing this method. Statistics show radial procedures have lower complication rates than femoral procedures, and better outcomes. Here's one doctor explaining why he thinks more of his colleagues should adopt the radial method:

"You'll reduce your likelihood of vascular complications by four times, and if you look at the most comprehensive head to head trial, the RIVAL trial, you'll see that you will not give up anything in terms of safety and efficacy. You will give up the fact that you will have more blood transfusions and more vascular complications going femorally and, if you look at the sites that were high volume radials, they actually had an improvement in hard outcomes -- that's MI, and morbidity, and mortality. So I think that if I could be so bold as to say, you're doing your patients a disservice if you don't at least consider radial an option in patients... even to the point that they request it... because the reality is, they are going to be requesting it." -- Dr. Richard Heuser, Chief of Cardiology at St. Luke’s Hospital and Medical Center in Phoenix, Arizona

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2. Is Wrist Angioplasty Right For Me?

The medical literature suggests that more than 90% of patients may be candidates for the wrist approach. However, only a doctor who knows the technique and understands your individual situation, your disease presentation, and your anatomy can diagnose whether you may benefit from a wrist angioplasty.

Radial angioplasty is not right for all patients; there's no such thing as "one size fits all" medicine. Overweight or elderly patients are often better suited to a radial procedure; individuals with small arteries or other contraindications may do better with a femoral approach. One way a doctor might choose to find out if the wrist approach is an option for you is through a simple Allen's test; you can read more about this in our Radial Approach Overview, so that you're ready for a detailed conversation with your physician.

If you are expecting to undergo a cardiac catheterization, take charge of your health by educating yourself on the radial approach so that you can talk to your doctor about whether you're a candidate.

Of course, finding out whether you're getting the procedure you prefer is only step one; make sure you have the doctor who is the best fit for you seeing your treatment through. If you're going to have a wrist angioplasty, be sure that your cardiologist has extensive experience using the radial approach. Insist that your cardiologist, and not an assistant, perform the actual hands-on introduction of the catheter. For more information on navigating your treatment to get the best care, visit our Patient Empowerment Center.

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3. How Will It Feel To Get A Wrist Angioplasty?

Patients like Geoff and Flora have written in to our Forum about what it's like to have a smooth radial procedure with no complications:

"The only pain was the incision into the artery which lasted about 30 - 45 seconds. After that I had no sensation of anything taking place. The recovery procedure involved a FemStop device applying pressure for 2 hours (the pressure was reduced over this time) and me lying on my back for this period. After two hours I was able to sit up for a further hour. I was then helped out of bed and walked about/sat on a chair as I chose. After four and a half hours I was allowed to go home... I felt absolutely nothing during the whole procedure and have had more trauma and pain visiting the dentist." -- Geoff, Warrington, Cheshire, United Kingdom, February 26, 2011 in our Transradial Patient Forum

"All I felt was a strong pressing into my wrist like with a thumb, then a few moments later a fluttering sensation in my heart. I was on & off' the table within about 20 minutes with the good news that my heart is OK. The needle puncture at my wrist is no bigger than a gnats head. I had no bleeding or pain and only minimal bruising." -- Flora, Hordaland, Norway, June 7, 2010 in our Transradial Patient Forum

Not every experience goes quite as effortlessly; as with any medical procedure, there is a risk of complications. One such complication is radial artery occlusion, where a blood clot forms in the radial artery, usually soon after the procedure. Sometimes this complication can be painful; often it has no symptoms. The occlusion may spontaneously dissolve over time, but if it doesn't, it may prevent use of the radial artery in future procedures.

Very rarely, complications have led to long-term problems, including pain in the hand or arm. However, serious complications with the transradial approach occur significantly less frequently than with the femoral approach. A recent study showed that vascular, bleeding or other complications, occurred in 1% of wrist cases, compared with 3.3% when accessing the heart through the femoral artery in the groin. As with any treatment, it’s important to discuss the risks directly with your physician, who knows you, your history, your risk factors, and your specific medical situation.

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4. What If I'm Having A Problem After My Procedure?

If you're having trouble after a radial procedure, contact the cardiologist who did the procedure ASAP.
The earlier you are able to give your doctor feedback about a problem, the more likely he or she is to be able to remedy the situation quickly and effectively, to both alleviate your immediate discomfort and minimize lasting damage.

The complication rate for the radial approach is lower than that for the femoral/groin approach, especially for serious problems such as bleeding. However, bleeding or other complications do occur sometimes with wrist access; if you are having a problem after a wrist procedure, don't hesitate to seek attention from the doctor who did the procedure, and who knows your situation and your individual case.

When you are discharged from the hospital you will be given a list of symptoms to watch out for. If you are experiencing bleeding, pain, swelling, or numbness in your wrist or arm contact the cardiologist who did your radial procedure and insist that you be checked immediately for a possible blood clot in the artery, since time can be of the essence in preventing long-term damage.

Individuals have written to our Patient Forum reporting arm and hand pain after the procedure: while the percentages are extremely low, it’s important to understand that these complications do occur. As with any medical procedure, discuss possible complications with your doctor before your procedure so that you understand the pros and cons and set up a line of communication with your cardiologist so that you know what to do if you experience post-procedure discomfort.

Researching your condition on a site like this one, by visiting our Radial Patient Forum or by reading our more detailed Radial Overview, can help you learn the vocabulary for an informed conversation with your physician, and we're proud to help empower and educate you to get the best care possible, but there's no substitute for actual medical attention.

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5. What About Financial Cost?

Because there's less post-procedure care required for a radial procedure than when using a groin access site, the financial cost of wrist angioplasty is generally lower than that of a traditional femoral procedure. The radial approach also makes it is feasible to do angioplasty as an outpatient procedure, potentially saving significant hospitalization costs. Outpatient angioplasty treatment is not widely available in the US, but may become so in the future as this option would be particularly helpful for uninsured patients who are footing the bill for care.
Here's one doctor's explanation of post-procedure care for radial patients:

"You don't need such extensive monitoring afterwards, in terms of the vascular complications, because the vascular complications are done by the time you get out of the lab. You put a TR band or any other kind of compression device on and it's very easily taken care of with a nurse -- a single nurse can take care of a number of patients." -- Dr. Richard Heuser , Chief of Cardiology at St. Luke’s Hospital and Medical Center in Phoenix, Arizona

The actual cost of a radial procedure (and whether it might be lower than a femoral procedure) depends on your insurance coverage, your location, the specifics of your treatment, and whether outpatient treatment is available at your hospital and appropriate for you. Compare notes with patients in your area on the Cost of Stent and Angioplasty discussion board in our forum.

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6. Why Doesn't My Doctor Do Wrist Angioplasty?

If you're asking this question, you're probably in the U.S.A., where radial approach procedures are much less common than in many other countries. Femoral access is still more common in the U.S., where less than 10% of procedures are done radially, although other parts of the world (like Japan, China and parts of Europe) do the majority of their procedures through the wrist.

There are multiple reasons for this, including economic incentives and the need for more professional training opportunities, which we discuss with more depth in our Radial Approach Overview, an article geared towards a professional audience which explains the current state of wrist angioplasty in greater detail.

What many experts in the field agree on is that patients can make a difference in getting more doctors and hospitals on board with radial access. By being educated and vocal about the radial option, patients put positive pressure on care providers to make this procedure more widely available. If you scan through our series of expert physician interviews in our Radial Access Center, you'll see "patient demand" mentioned as a driving force for radial procedures in almost every interview.

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7. Where Can I Find A Doctor Who Does This Procedure?

Radial Hospital Locator
    Our Radial Hospital Locator lists over 170 hospitals in the United States-- and worldwide-- known to offer transradial access for percutaneous coronary interventions (PCI) and angiograms.

We are proud to provide this information free of charge, with no cost to patients or to the hospitals we list.

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8. Where Can I Learn More About Wrist Angioplasty?

Take the next step by visiting our Radial Approach Overview, which offers a fuller picture of this procedure, including a more detailed breakdown of how cardiologists decide which patients are good candidates for a wrist angioplasty.

You can find in depth coverage for patients and professionals including cutting edge news about radial approach techniques, interviews with medical experts, and more in our Radial Access Center.

You can read patient comments, ask specific questions, and talk about the procedure in our Transradial Patient Forum.

For more information that will empower you to get the best overall treatment available for your heart condition, check out Five Crucial Questions to Ask Your Doctor About New Heart Disease Treatments along with other action resources in our Patient Empowerment Center.

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Published by Angioplasty.Org Staff, October 5, 2012