Traditionally, both angioplasty and angiography was performed by approaching the heart through the femoral artery by making an incision near the groin. But in the 1990s, cardiologists abroad started using the artery of the wrist to carry out both. Now, informed patients in India are driving a shift in approach.
Several cardiac centres in Mumbai have switched from the femoral to the radial (wrist) route. It is estimated that at least 8,000 patients undergo angioplasty in the city every year and more than double the number undergo angiography.
"There has been at least a 30% increase in the radial approach in the last couple of years," said interventional cardiologist Dr Anand Rao, who consults with BSES in Andheri and Holy Family Hospital, Bandra. Angiography, when performed through the groin artery, requires a patient to lie down for at least six hours with a sand bag placed at the puncture site to ensure there is no bleeding. "The same procedure done through the wrist allows the patient to go home in less than four hours," said Dr Brian Pinto, interventional cardiologist at Holy Family Hospital.
In Europe and Japan, radial artery is the primary approach and only exceptional cases are tackled through the groin. In India, Gujarat and Tamil Nadu have made the shift. "In Mumbai, the ratio would still be 80:20. But a shift is surely happening," said Dr Dev Pahlajani, head of interventional cardiology at Breach Candy hospital. He said a lot of it depends on the patient's condition, hospital policy and the choice of cardiologist.
Pinto said, "Cardiologists need to be proactive and think of the patient's benefit rather than their own convenience. In the US, insurance companies force doctors to adopt this approach, as they want patients to go home early."
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