Cardiologist introduces life-saving procedures
It is performed through the left wrist artery with the support of a special arm brace.
Dr Fanie Fourie, a cardiologist at Mediclinic Nelspruit, continues to save lives through innovations and safer procedures. An investigative life-saving heart procedure was recently performed with access to the heart made from the left arm, referred to as the interventional radial angiogram.
It is performed through the left wrist artery with the support of a special arm brace. Years ago, Fourie was the first doctor in Mpumalanga to perform an interventional radial angiogram through the right-hand side. An angiogram is when a thin tube (catheter) is placed into a blood vessel after administrating medication through the vein for sedation.
The catheter is then threaded through the blood vessels to the heart to study the blood flow and determine the area that needs medical attention.
There are three kinds of angiogram: the femoral, done through a blood vessel in the groin, the brachial, done through the elbow, and radial, done through the wrist. The radial artery is much smaller and located closer to the skin’s surface. The left-wrist side angiogram is quicker and safer for patients, said Fourie.
“We are now using the left radial access instead of the right one. This is made possible due to Mediclinic Nelspruit acquiring an arm brace. It is much easier and more comfortable for the patient.
It was developed for the left side, whereby we access the left radial artery. Previously we had used the femoral angiogram. We then introduced the radial procedure and we observed less bleeding tendencies.
“After introducing the right-hand access, we discovered new, better ways to help improve that procedure. The problem is that the anatomy is very difficult on the right side and some patients are not suitable for it,” Fourie said.
“During the left-wrist side access procedure, the arm is moved over to the right side of the patient and is supported by the brace. The access to go to the coronary arteries is made easier and it is more of a natural pathway. We are now able assist more people and more patients are eligible to be done on the left-hand side. The right-hand side anatomy was limiting, and for the left-hand side, 95% of the time it is straight down when inserting the catheter,” he explained.
“The benefits of this procedure are that it is safer, with less bleeding risk, and more comfortable for patients. A big plus factor is that the X-ray exposure to the patient and medical staff is less. The patient does not have to lie down afterwards like they would after the femoral artery procedure. After the catheter is removed, a compression device is placed around the wrist to apply pressure on the artery.
In Covid-19, if it happens that we have limited beds, this procedure makes it easy to continue with surgery and send them home the same day; the bleeding tendency has been minimised by this left radial access,” Fourie said.
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“After the procedure is finished, two protocols are done to determine the condition. The first is when the intervention was done and the second one is when the blood thinners were administered.
If it was a high-risk procedure, the patient would stay overnight. If it was a diagnostic procedure and no blood thinners were administrated within two hours and have been deflated, the patient could be released in three hours,” he said.
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