Does your doctor suspect you have a heart blockage and need a stent? Or, perhaps he or she needs to confirm that a problem exists. Either way, you may need a cardiac catheterization. The question is, how will your doctor get to your heart — through an artery in your leg or in your wrist? Is one a better, safer option?
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Overall, a leg and wrist catheterization are similar. Both require sedation and numbing at the access point. Your doctor inserts a needle into your artery and threads a thin catheter to your heart, using contrast dye to follow it as it moves. If you have a blockage, he or she may implant a stent to increase blood flow.
However, going in through your wrist — known as transradial catheterization — is less risky and more comfortable, says cardiologist Stephen Ellis, MD, Section Head of Invasive and Interventional Cardiology at Cleveland Clinic.
He says there are three main benefits of approaching the heart through your wrist.
1. Your risk of bleeding is lower
If your doctor goes in through your wrist, your risk of bleeding post-procedure drops significantly, Dr. Ellis says. In fact, the likelihood falls by half, and it’s easier to stop any bleeding that may occur.
Bleeding from the leg is a different story.
“The artery in the leg is deep within the thigh, and it’s hard to detect any bleeding,” he says. “With the wrist, the opportunity to see it is right there on the surface.”
2. You’ll be up and about faster
Immediately after your wrist catheterization, you can sit up. In addition, you’ll only need to wear a pressure bracelet over the access point for a few hours, Dr. Ellis says.
Treat your wrist like it’s broken for about 24 hours, he says. But otherwise, you are free to resume normal activities.
With a leg catheterization — known as transfemoral catheterization — you’ll need to lie flat for two to five hours to safely close the access point. Lying flat helps prevent blood from oozing from the hole in your leg artery, he says.
3. You’ll have less risk of heart attack
It’s unclear exactly why, but if you’ve had a previous heart attack, you’re less likely to die with a wrist catheterization, Dr. Ellis says.
“We think the benefit exists because, in heart attack cases, doctors prescribe blood thinners. With the increase of bleeding with the leg, they have to back off using blood thinners, so the heart attack risk increases,” he says. “With the lower likelihood of bleeding, a wrist catheterization side-steps that risk.”
The wrist is not always an option
Although a growing number of hospitals and doctors are using wrist catheterization, there are still some situations where it might not work, Dr. Ellis says.
You’ll want to discuss your individual situation with your doctor, but here are some instances where the wrist approach may not work as well:
- You have artery spasms in your forearm.
- The artery in your arm is too small.
- There are severe bends between your wrist and your heart, which is most common in older adults who have osteoporosis.
Whatever the case, talk with your doctor. When choosing a physician to perform the procedure, look for one who does a high number of them every year, Dr. Ellis says. This can help to ensure a higher level of expertise compared with someone who does it only once in awhile.
“Always make sure to ask about the safety of the procedure in your specific case,” he says. “And don’t ever be shy about asking about how many of these procedures he or she has done — is it routine for them or is it unusual?”