Chances are, you or a loved one has been directly affected by heart disease.
February is American Heart Month, and awareness of cardiovascular disease, including stroke, as the country’s No. 1 killer is at an all-time high. It’s a shocking fact that heart disease is the leading cause of death for men and that one in four women die annually from effects of the devastating disease.
Two causes of coronary heart disease include coronary artery disease (CAD) and peripheral vascular disease (PVD). CAD is a build-up of plaque that thickens the interior lining of an artery resulting in an increasingly constricted blood vessel, which diminishes the blood flow and essential oxygen and nutrients to the heart. PVD is a partial or complete blockage of the circulation of blood through the larger arteries to limbs and vital organs such as the brain, kidneys and intestines.
Similar to other areas of modern medicine, treatment in the area of heart disease continues to advance at a rapid pace, and Kansas City-
area patients have access to a procedure that has been widely adopted in Europe and is gaining popularity in the U.S.
Catheterization, performed to both diagnose and treat CAD and PVD in a hospital’s catheterization laboratory, traditionally accesses a chamber or vessel of the heart through the groin’s large femoral artery and requires a patient to lie still for several hours. In addition, walking can be uncomfortable for several days afterward.
Transradial angiography, in contrast, threads a catheter through the small radial artery in the wrist, a technique that offers patients decreased recovery time and helps reduce hospital costs. In order to introduce the catheter using this option a small puncture is made at the patient’s wrist. A person undergoing a transradial catheterization is able to immediately sit up, eat and walk without pain and discomfort and can return to normal activities.
Daniel Scharf, MD, FACC, medical director for cardiology services at Menorah Medical Center and a cofounder of one of Kansas City’s oldest cardiology practices, Midwest Cardiology Associates, PA, says only about 2 percent of coronary interventions use the transradial procedure in this country.
“The issue of not using it as frequently as the groin-inserted guiding catheter is more of a learning curve and a lack of familiarity by many practitioners, yet it offers many attractive benefits,” says Scharf.
Scharf says the traditional method of accessing the heart through the groin is often easier because the artery is larger.
“Going through the groin can be problematic for several reasons, including a patient’s recovery experience,” says Scharf. “Instant mobility is attractive.”
Although complications from the standard method of catheterization through the groin are relatively low, occurring in only 2 to 9 percent of patients, the transradial approach can reduce bleeding to less than 1 percent in most patients. This is the most common complication, especially among women and the elderly.
Scharf has performed the transradial cardiac catheterization on patients for 15 years and says one of the reasons some doctors are reluctant to use the technique is because it requires a more exact manipulation of the catheter.
“We now have catheters [small, hollow tubes] that are quite thin and very maneuverable,” says Scharf. “Better wires and stents have been developed, too, which allow us to perform angioplasty utilizing the radial artery approach.”
In addition to caring for patients at Menorah Medical Center, Midwest Cardiology Associates sees patients at Overland Park Regional Medical Center, Centerpoint Medical Center, Research Belton Hospital and Providence Medical Center. The practice has diagnosed and treated CAD and PVD since the 1980s and uses state-of-the-art facilities to provide comprehensive vascular care for patients.
“We take the least invasive approach possible,” says Scharf. “Typically that means we begin treatment with medications and lifestyle changes such as diet and exercise, and if that doesn’t produce the necessary results, we then investigate techniques such as angiography, angioplasty, atherectomy and stent procedures.”
With many patients, surgery is often unnecessary and unlike many open surgical procedures, these less invasive procedures can be performed without general anesthesia or large incisions. The advantages of minimally invasive procedures include smaller wounds, less pain, faster healing times and lower risk of infection.
Initially, a standard angiogram is performed with the purpose of allowing the doctor to get pictures of the heart to determine any blockage and whether surgery, angioplasty or a stent procedure is required. The first step in the angiogram is to get a catheter into the heart to engage an artery and identify the nature of the blockage before clearing it.
“Transradial cardiac catheterization is another tool in our arsenal to help effectively treat coronary heart disease earlier enough to prevent heart attacks from claiming more lives,” says Scharf.
For more information on Midwest Cardiology Associates, visit www.midwestcardiology.com.
words: Kimberly Winter Stern
photos: Rachel Swetnam