The patient had arrived a few days earlier complaining of chest pains, reason unknown.
The case, while not an emergency, was deemed a priority. Doctors at Penn State Milton S. Hershey Medical Center determined it would be best to use a cardiac catheterization to determine a diagnosis — itself a not-uncommon procedure.
In a cardiac catheterization procedure, a small tube is entered into the bloodstream, usually through the femoral artery in the groin. From there, it is run into the heart itself, where it can be used for a variety of purposes. For diagnostics, the catheter is used to deliver an X-ray solution, which allows doctors to have a real-time video image of the patient’s heart and surrounding arteries.
Almost 97 percent of the catheterization surgeries conducted in the U.S. are done through the groin. For doctors, the femoral provides a straight shot to the heart.
But for patients, the surgery is uncomfortable. They must remain prone for several hours afterward to avoid irritating the spot where the procedure was conducted. From a medical standpoint, the femoral also carries a few risks. It is one of the major arteries that provides blood to the body. If a patient were to begin bleeding post-op and it went untreated, it could be fatal.
Over the last few years at the hospital, however, a femoral procedure has become somewhat atypical rather than the norm.
Today, more than 50 percent of the 2,000-plus annual catheterization procedures performed at the center are done through a radial vein, located just below the flesh in the wrist.
A technique pioneered in Europe, it was brought to the medical center by heart surgeon Dr. Mark Kozak, who had heard it was starting to be widely used in Canada. He spent a week in a Canadian hospital, studying the procedure.
“I didn’t believe it and had to see it for myself,” he said.
The radial procedure had a number of positives that piqued his interest, he said.
From a medical standpoint, the possibility of a bleed-out is much less than it is using the femoral artery. Radial veins transport a small amount of blood comparatively, and any surface or even subsurface bleeding would be very obvious. From patients’ perspective, the surgery is more comfortable. There is no impact on mobility, no need to stay off their feet for hours or possibly days while they heal.
Patients can literally walk away from the surgery, and out of the hospital, the same day.
Another positive: The two procedures are viewed almost identically in the eyes of insurance coverage.
The procedure itself is a little more difficult than using the femoral artery, but the positives for Kozak outweigh the negatives.