Opening Your Heart

What is catheterization?
Catheterization provides an anatomical illustration of the arteries that feed the heart – coronary arteries – via an x-ray. This image, produced by injecting a contrast medium (iodine) into a catheter that has been inserted into the radial artery, will highlight the heart's arteries for several seconds. This x-ray makes it possible to capture an image of the artery's anatomy and identify the location of an obstruction or narrowing of the heart's arteries.

When an obstruction is diagnosed, it can be opened with a special balloon with the help of a stent, which protects the arterial structure and enables blood to flow continuously in the cardiac arteries.

Methods of Catheterization
There are currently two main approaches to catheterization:

• Catheterization through the groin (femoral artery)
• Catheterization through the wrist (radial artery)

The method most commonly used in Israel (still) is catheterization through the groin, which requires a relatively long hospital stay, several hours of which must be motionless, and causes tremendous discomfort to the patient.

As opposed to this method, catheterization through the wrist is less awkward and requires a shorter hospital stay, but requires a particularly high level of skill, because insertion of the catheter into a major artery through the hand requires passing through a large number of extremely narrow and convoluted blood vessels.

Despite the aforementioned difficulty, Dr. Aaron Frimmerman, Director of the Catheterization Unit and the person who diligently introduced the method at Hillel Yaffe Medical Center, says that this method of catheterization through the wrist offers numerous advantages:

First, unlike the more common method of catheterization through the groin, patients do not need to lie motionless for several hours following the procedure.

Second, a quicker, less painful recovery process that does not require hospitalization. In principle, patients who undergo catheterization through the wrist can immediately "get up and go" once the procedure has been completed, thereby shortening the follow-up time following catheterization.

In fact, Dr. Frimmerman claims that the main difference between the methods relates to the patient's quality of life, something that all believe is the most significant difference.

Recent international large-scale studies found that the radial approach applied during myocardial infarctions ("heart attack") resulted in less bleeding at the radial site than at the femoral site. This resulted in a significant decrease in mortality and morbidity among myocardial infarction patients who were catheterized with the radial approach vs. those catheterized with the femoral approach.

How is the procedure performed?
Before the procedure, a kind of sleeve is placed on the patient's hand and fixed into place to ensure that the hand does not move. Immediately after the catheterization has been performed and completed, the tube that was inserted into the artery and used as a guide for insertion of the catheter is retracted to outside the body, and the injection site is closed with a special pressure bandage that is removed several hours later. Catheterization is generally performed on the right hand since access is easier for the doctor performing catheterization, unless use of the right hand in catheterization was ruled out.

The new approach requires composure and decisiveness. The doctor performing the catheterization must have undergone special training for the procedure and developed the special skills required for success.

The use of catheterization through the wrist at Hillel Yaffe Medical Center began six years ago and has since become the primary method used. Approximately 90% of all catheterizations performed at Hillel Yaffe Medical Center are performed with this method, and the number is growing. Catheterization through the groin is still used primarily for medical reasons such as a small and convoluted radial artery or tendency to spasm, patients who have had bypass surgery, patients with certain diseases, and the like. That said, the department tries to use the wrist catheterization method for most patients.

In conclusion: The radial approach to coronary catheterization (through the wrist) is evolving. The approach requires tremendous skill on the part of the physician and a prolonged learning curve for both the physician and the supportive nursing staff. 

Catheterization through the radial artery offers numerous advantages in terms of satisfaction of patients and caregivers alike, as well as fewer complications at the catheter insertion site into the artery, shorter hospital stay and even reduced risk of morbidity and mortality during myocardial infarction.

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