New procedure benefits patients

By KALEY CONNER

kconner@dailynews.net

Since undergoing a heart transplant 12 years ago, Lloyd Snook has lost count of how many routine heart catheterizations he has had done.

For Snook, that process meant uncomfortable surgery through the groin, several hours of lying flat on his back in a hospital bed, and several more days to recover. That's not so anymore, the Russell resident said.

About two weeks ago, he was admitted to Hays Medical Center for another routine diagnostic cath procedure. He was able to move immediately after surgery and go home an hour later.

The difference? The procedure was performed through a smaller artery in the wrist.

"I was real pleased with the procedure and the way it went," Snook said. "I'm glad I went that route."

The cardiac procedure utilizes the wrist's radial artery to thread a thin plastic tube into the heart. The procedure can be used for diagnostic imaging or to insert stents to prop open blocked blood vessels.

Dr. Richard Markiewicz, who began work at Hays Med in October, prefers to perform cath procedures through the wrist instead of the groin.

National statistics suggest about 8 percent of cardiac catheterizations are performed through the wrist. The procedure is more common in Japan and Europe, he said.

Advocates of the procedure say it results in increased patient comfort and reduced risk of post-surgery bleeding.

If a patient bleeds following a traditional hearth cath, statistics suggest six-month mortality risks will increase significantly, Markiewicz said.

"The idea of doing a minimally invasive procedure, even through the femoral artery, is to avoid the hassle and the complications of surgery," Markiewicz said. "But if you end up with a huge hematoma and you have pain in your leg and you need subsequent procedures to repair that artery in the leg -- well then, in many ways, it became a surgery."

A typical diagnostic procedure takes about 15 minutes to complete, he said. Patients are given a small amount of sedation, but not enough to completely put them to sleep. Many patients, in fact, get up off the surgery table on their own following radial procedures, Markiewicz said.

"The only restriction is when you go home, you don't want people lifting heavy things with that wrist for a couple days," he said. "But we encourage them to be up and about after that cath, and patients like it."

Earlier this month, Markiewicz said he had performed about 170 heart catheterizations since beginning work in Hays. About 80 percent of those procedures have been performed through the wrist, Markiewicz said, noting he discusses the two options first with patients.

Some patients, however, simply are not good candidates for the radial procedure. If tests determine a patient does not have good circulation to the hands, the groin still would be the preferred point of entry, he said. The method also might not be optimal for some elderly patients because the wrist artery can become twisted over time.

The procedure, however, is not without risk, he said.

"It's safer. But any time you're working on a running engine in the blood vessels with things that aren't supposed to be there, there is always that element of risk," Markiewicz said.

But for some patients, such as David Leiker, the procedure is seen as a blessing. Leiker, a Munjor resident, suffered a heart attack one Friday in late January and was taken to Hays Med with 100 percent blockage.

He had three stents put in through his wrist over a three-day period, and was amazed how slight the pain was.

"After the first procedure on Friday night, Saturday morning, I had no pain. I'm sitting there trying to find some pain in my arm and there wasn't any," he said. "It was totally amazing."