Harvard Heart Letter

Wrist artery a safe approach to the heart

Angioplasty via the radial artery in the arm is a good alternative to the approach via the groin.

Artery-opening angioplasty uses the body's circulatory system as a highway to the heart. The traditional on-ramp has been the femoral artery in the groin. An alternative is the radial artery in the wrist. Two studies suggest that the radial artery may be a touch safer than the femoral artery. And people having angioplasty often prefer the wrist approach.

Make no mistake "" the femoral artery is an excellent conduit for angioplasty. It is large enough to accept balloons, stents, and other miniaturized hardware. It also offers a direct route to the heart. But the femoral artery can be hard to reach, especially when it is buried under layers of fat. Bulges of cholesterol-filled plaque in the femoral artery and aorta can create roadblocks for angioplasty tools. Stopping bleeding once the procedure is over requires heavy pressure "" think sandbags "" at the puncture site. It also means lying still for several hours, something that can be tough on anyone with lung disease, heart failure, or hip or back pain. Another problem is that blood from the puncture sometimes seeps backward into the leg or abdomen and isn't immediately apparent. Such blood loss can require a transfusion, a procedure you'd rather avoid if possible.

The radial artery gets around some of these limitations.

Key points

  • Although most U.S. doctors begin angioplasty at the femoral artery in the groin, it can also be started in the radial artery near the wrist.

  • Studies show that radial artery angioplasty is as effective as femoral artery angioplasty, and may be a bit safer.

The radial approach

The radial artery runs from the elbow to the wrist along the underside of the arm. Along with the ulnar artery, it delivers blood to the hand. When you take your pulse by pressing two fingers along your wrist just below the thumb, you are feeling the steady pumping of blood through the radial artery.

This artery is a good starting point for angioplasty for several reasons. It sits close to the skin, even in people who are overweight. That makes it easier to access. It is also easier to detect and stop post-angioplasty bleeding around the radial artery than it is around the femoral artery. From the recipient's perspective, angioplasty via the radial artery is easier "" you can get up and walk around soon after the procedure instead of lying flat for several hours.

The radial approach may also be safer. In a Canadian study, people who had radial artery angioplasty needed a transfusion less often (1.4%) than those who had femoral artery angioplasty (2.8%). Deaths in the year following the procedure were also lower: 2.8% in the radial artery group and 3.9% in the femoral artery group (Heart, August 2008). A larger U.S. study showed that the radial artery approach was as successful as the femoral artery approach but was also safer, with lower rates of bleeding and other complications (JACC Interventions, August 2008).

Using the radial artery as the access point for angioplasty isn't perfect, of course. This artery is smaller than the femoral artery, and it has more twists and turns. Both of these factors challenge doctors' dexterity. Tugging catheters through this artery can irritate it and make it clench, halting blood flow. That's why it is essential to make sure the ulnar artery can supply blood to the hand all by itself. Doctors check this with something called the Allen test. If the ulnar artery isn't up to the task, then angioplasty via the radial artery isn't a good option.

Radial artery angioplasty

Starting artery-opening angioplasty at the radial artery in the wrist is a safe alternative to starting it at the femoral artery in the groin.

Gaining ground

The radial artery approach got its start in the Netherlands in the early 1990s. Today, in parts of Europe and Japan, up to 40% of all angioplasties are now done through the radial artery. In the United States, though, the proportion is barely 2%.

If you are facing elective angioplasty, it isn't worth making a special trip to a distant medical center to have yours done through the wrist unless angioplasty via the groin isn't an option for you. But if you have a doctor who routinely uses the radial artery approach, it may be the way to go.