Coronary Artery Disease.. and Coronary Angiography
Coronary angiography (CAG) or contrast injection is an important diagnostic and treatment procedure for coronary artery disease. The doctor inserts a small catheter into the artery just before the heart, then injects a contrast dye through the catheter to the coronary arteries and takes images to check for narrowing or blockage of the arteries. This helps determine the appropriate treatment, which depends on the severity of the disease, whether medication, balloon angioplasty, or stent placement.
“Femoral Approach” The basic method everyone uses
Coronary angiography performed via the femoral artery uses local anesthesia without general anesthesia or surgery. This means the patient remains conscious and can communicate. Although the procedure takes only 30-60 minutes, the patient must lie flat and keep the leg straight for about 6 hours afterward and cannot sit or walk. If balloon angioplasty or stent placement is needed, it can be done immediately. Patients can usually go home within 1-2 days and return to normal activities within a week.
More advanced with “Transradial Approach”
With current technological advancements, coronary angiography can now be performed through the radial artery at the wrist. Although the artery is smaller and more tortuous, equipment has been developed to make the procedure comparable to the femoral approach. This method is increasingly popular; for example, in the United States between 2007-2011, the number of patients undergoing transradial coronary angiography increased nearly tenfold.
In-depth look at the “Radial Artery at the Wrist”
Normally, the wrist is supplied by two arteries: the radial and ulnar arteries. Doctors perform a simple test called Allen’s test to check if both arteries are normal and suitable for coronary angiography via the wrist. More than 90% of patients have normal arteries in both vessels.
Everything has two sides, so does treatment
This method may be more challenging for doctors as it requires greater skill, and sometimes radial artery spasm occurs. If severe, the procedure may need to be switched to the femoral approach. However, there are many advantages, such as patients not needing to lie with their leg straight for hours after the procedure. They can get up to use the bathroom and eat. Only a wristband (TR band) needs to be worn for about 2-4 hours (see figure 5). This shortens hospital recovery time, allowing patients to return to normal life within a few days. Local complications from catheter insertion are much lower than with the femoral approach because the artery is smaller and closer to the skin, making bleeding easier to control. In contrast, bleeding from the femoral artery may require blood transfusion or surgery for aneurysm repair, which can prevent patients from bending their leg or walking for weeks.
Choosing the appropriate method for the best outcome
Generally, the decision depends mainly on the doctor performing the procedure. Some doctors primarily use the femoral approach, while others increasingly use the radial approach. The doctor must be highly skilled. For very obese patients or those with peripheral artery disease in the legs, the radial approach has more advantages. However, in cases where preserving the radial artery for other treatments such as hemodialysis or coronary artery bypass grafting (CABG) is necessary, the femoral approach may be more appropriate.
Prevention first with a “Heart Healthy Life” lifestyle
Healthy lifestyle behaviors can reduce the risk of sudden cardiac arrest and heart disease. Start with eating healthy foods such as vegetables, fruits, legumes, and fish; exercising regularly, such as brisk walking for about 30 minutes almost every day; maintaining a healthy weight; not smoking; and managing chronic diseases, especially diabetes, hypertension, and high cholesterol.
Comparison between transradial and transfemoral coronary angiography
|
Coronary Angiography |
Via Wrist |
Via Groin |
| Post-procedure bed rest | Not required | About 6 hours |
| Local vascular complications | 1.4% | 3.7% |
| Success rate of diagnosis and treatment | 95% | 95% |
| Patients choosing wrist approach next time | 90% | 50% |
