Radial surgery not so radical

Mercy doctor places stents through wrist

Fraley Enlarge photo

Fraley

When Dr. Alex Fraley joined Mercy Cardiology Associates in August, he brought with him a technique for placing stents in heart arteries not used in Southwest Colorado.

Fraley, an interventional cardiologist, introduces stents through the radial artery in the wrist as well as the traditional access point the femoral artery in the groin.

Radial access hasnt caught on in the United States, where probably fewer than 5 percent of stents are placed into heart arteries through the wrist, Fraley said.

In Canada, 50 percent of stents go in through the wrist, Fraley said. In Europe, the number is even higher up to 70 percent, he said.

A stent is a tiny mesh tube of steel, cobalt, titanium or platinum about an inch long that is slipped through a catheter into a blocked heart artery to prop it open.

Linda Young, director of critical care at Mercy Regional Medical Center, said the hospital simply was looking for an interventional cardiologist but not a surgeon trained in any specific technique when Fraley was hired.

We hadnt seen radial access here, but hes well versed in several procedures, Young said. Its a nice option to have.

While not new, radial access is patient-friendly, Young said. Patients dont have to lie flat and keep their leg straight for six to eight hours after surgery to avoid post-procedural bleeding as they do with femoral access, she said.

Freddie Tallent, a registered nurse and manager of the Mercy Regional Medical Center catheterization laboratory, said the radial artery is a tailor-made access point for so many stent recipients.

Cath lab nurses and technicians prepare patients for surgery and see them immediately after their operation.

Fraley earned an undergraduate degree in political economy of industrial societies at the University of California, Berkeley. He attended medical school at the University of Utah and then did specialized studies at the University of California, San Diego, the William Beaumont Hospital in Royal Oak, Mich., and El Camino Hospital in Mountain View, Calif.

Mercy cardiologists examine more than 400 patients a year as candidates for stents, Fraley said. About 100 patients receive them.

Fraley said the advantage of using the radial artery is its accessibility and its smaller size, which make bleeding easier to stop. But the smaller artery makes the learning curve steeper for surgeons because the catheter is more difficult to guide through a narrower passageway.

A 2009 editorial in Journal of the American College of Cardiology, noting the differing opinions concerning radial versus femoral access, concluded there is need for both approaches.

In the end of this debate, we must conclude that to treat all patients, superior operators and labs should be very good at both approaches, wrote Dr. Morton A. Kern of Orange, Calif.

Another advantage is the comfort of patients, who can be on their feet almost immediately after an operation. The wound is stopped with a wrist compression band, allowing the patient to walk almost immediately.

daler@durangoherald.com

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