Deep vein thrombosis in the arm following transradial cardiac catheterization: An unusual complication related to hemostatic technique

Upper extremity deep vein thrombosis with tourniquet use

INTRODUCTION

Upper extremity deep vein thrombosis is an increasingly important clinical finding with significant morbidity and mortality. The condition may be under-diagnosed in trauma and surgery settings.

PRESENTATION OF CASE

We present a case of upper extremity thrombosis with venous congestive symptoms secondary to the use of an operative tourniquet. A literature review and discussion of the causes of upper extremity deep vein thrombosis and the pathophysiological disturbances seen with tourniquet use are presented.

DISCUSSION

Upper extremity deep venous thrombosis is uncommon. In this case the likely cause was operative tourniquet use.

CONCLUSION

Operative tourniquet may be a risk factor in upper extremity deep vein thrombosis.

Interruption of blood flow during compression and radial artery occlusion after transradial catheterization

OBJECTIVES

To analyze the possible relationship between compression after transradial catheterization and radial artery occlusion.

BACKGROUND

Radial artery occlusion is an important concern of transradial catheterization. Interruption of radial artery flow during compression might influence the rate of radial artery occlusion at follow-up.

METHODS

A prospective study including 275 consecutive patients undergoing transradial catheterization was conducted. Arterial sheaths were removed immediately after procedures and conventional compressive dressings were left in place for 2 hr. The pulse oximeter signal in the index finger during ipsilateral ulnar compression was used for the assessment of radial artery flow.

RESULTS

Radial artery flow was absent in 174 cases (62%) immediately after entry-site compression. After 2 hr of conventional hemostasis, radial artery flow was absent in 162 cases (58%) before bandage removal. At 7-day follow-up, 12 patients (4.4%) had absent pulsations and radial artery flow was absent in 29 cases (10.5%). Patients with an occluded radial artery at follow-up had significantly smaller arterial diameters at baseline (2.23+/-0.4 mm vs. 2.40+/-0.5 mm; P=0.032) and more frequently had absent flow during hemostasis (90% vs. 54%, P<0.001). Stepwise logistic regression analysis revealed that absent flow before compressive bandages removal was the only independent predictor of radial artery occlusion at follow-up (OR=6.7; IC 95%: 1.95-22.9; P=0.002).

CONCLUSIONS

Flow-limiting compression is a frequent finding during conventional hemostasis after transradial catheterization. Absence of radial artery flow during compression represents a strong predictor of radial artery occlusion.

Quantitative analysis of catheter roughness induced by cutting and manipulation: a potential prothrombotic risk

Thrombosis is a major complication of central venous access devices, its incidence depending on material, diameter, tip position, and tip surface. Catheters are usually cut to the appropriate length for accurate positioning. Cutting is not recommended, however, as rough surfaces can serve as a nidus for thrombosis. The present study was performed to assess the roughness of catheter tips provided by various manufacturers versus the roughness once cut and handled. Three types of catheters (Hickman, Port-a-Cath, and Per Q Cath) were cut by scissors, iris scissors, or scalpel, and were handled with debakey forceps, a needle driver, adson with teeth or adson without teeth, to determine the damage created on the catheter. The uncut manufactured tip was compared as a control. Scanning electron microscopy was used for imaging of all samples, and roughness was quantified by atomic force microscopy for the cutting methods. Qualitative results by scanning electron microscopy showed that scalpel-cut and manufactured ends appeared smoother relative to those cut with scissors or iris scissors. This complemented the roughness analysis by atomic force microscopy. Catheters handled by debakey forceps and adsons with teeth showed most roughness, visible as deep holes or a grainy surface when observed by high-magnification scanning electron microscopy. Overall, the smoothest result was produced by scalpel, followed by the manufactured end, scissors, and iris scissors. Handling should be minimized, and use of adsons with teeth, needle drivers and debakey forceps should be avoided, as they can leave permanent damage. Adsons without teeth appeared the least damaging.