As soon as the doctor diagnoses that the patient is at risk of coronary artery disease, the doctor will recommend the patient to undergo coronary angiography to precisely locate the blockage in the blood vessels and proceed with treatment as soon as possible to reduce the risk of complications. If the heart lacks blood supply, the patient is at risk of heart attack and has a high chance of death.
Coronary Artery Disease.. and Angiography
Coronary artery angiography (CAG) or angiogram is an important diagnostic and treatment procedure for coronary artery disease. The doctor inserts a catheter about 2 millimeters in diameter into the artery, starting at the wrist or groin, up to the opening of the coronary artery. Then, a contrast dye is injected through the catheter to flow into the coronary arteries, followed by periodic X-rays to observe the condition of the heart muscle, the function of multiple heart valves, and to check for any narrowing or blockage in the coronary arteries.
“Femoral Approach” – The Basic Method Everyone Uses
Coronary angiography performed via the femoral artery is one of the most popular methods. The doctor uses only local anesthesia, no general anesthesia, and no surgery is required. This means the patient remains conscious and can communicate throughout the procedure, which takes only 30-60 minutes.
In cases requiring treatment with balloon angioplasty or stent placement in the coronary arteries, these can be done immediately afterward. However, the patient must lie flat in bed and cannot sit up or walk, and must avoid bending the leg on the side of the procedure for about 6–12 hours or as advised by the doctor. The patient can usually go home within 1-2 days and return to normal activities within a week.
More Advanced with “Radial Approach”
Thanks to medical innovations, doctors can now perform coronary angiography through the radial artery at the wrist. Although the artery is smaller and more tortuous, equipment has been developed to be suitable for this approach, allowing diagnosis and treatment comparable to the femoral artery method. Before the procedure, doctors perform a simple test called Allen’s test to check if the radial artery approach is feasible, which is possible in over 90% of patients.
Although this method may be more challenging for doctors as it requires more skill and sometimes causes radial artery spasm, which if severe may require switching to the femoral approach, it has many advantages. For example, patients do not need to lie with their leg straight for hours after the procedure and can walk and eat soon after. Only a wristband (TR band) needs to be worn for about 2-4 hours, and patients can return to normal life within a few days. This method is becoming increasingly popular.
Choosing the Appropriate Method for the Best Outcome
Generally, the decision on which artery to use for coronary angiography depends mainly on the doctor performing the procedure. For patients who are overweight or have peripheral artery disease in the legs, the radial artery approach has more advantages. However, in some cases where the radial artery is needed for other treatments such as hemodialysis or coronary artery bypass graft surgery (CABG), the femoral artery approach is more appropriate.
Comparison Between Radial and Femoral Coronary Angiography
| Coronary Angiography | Radial Approach | Femoral Approach |
| Bed rest after angiography | Not required | About 6 hours |
| Local vascular complications | 1.4% | 3.7% |
| Success rate of diagnosis and treatment | 95% | 95% |
| Patients choosing radial approach next time | 90% | 50% |
