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Ying Y, Lin XJ, Chen MJ, Cao Y, Yao YT. Severe ischemia after radial artery catheterization: A literature review of published cases. J Vasc Access 2024; 25:767-773. [PMID: 36267019 DOI: 10.1177/11297298221101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Severe ischemia is a rare complication of radial artery catheterization (RAC). This study aims to summarize risk factors of RAC-elicited severe hand ischemia, preventive, and therapeutic management. METHODS Literature search was conducted in eight electronic English and Chinese databases to identify relevant published cases. Data of interest was extracted and analyzed. RESULTS Database search identified 28 articles reporting cases of 57 patients developing hand ischemia following RAC. Patients aged between 1 day and 88 years. The indications for RAC included surgery, shock, cardiac arrest, and Neonatal Intensive Care Unit (NICU) admission. Identified risk factors included pre-existing vascular diseases, hypotension, arterial anatomical abnormality or small diameter, vasoconstrictors, and catheter-related problems. Totally, 18 patients complained pain; 32 developed discoloration; 19 pulselessness; 3 paresthesia; 13 swolleness and 19 coldness. Eventually, 30 patients recovered well, but 20 patients unfortunately underwent digital amputation and three patients deceased due to non-RAC-related causes. CONCLUSION Severe hand ischemia following RAC is a rare complication, with the reported incidence of approximately 0.09%. There is no definite predictor for RAC-related hand ischemia, but patients with risk factors are prone to the occurrence of hand ischemia. It's vital to initiate early recognition and proactive strategies for a best practice RAC insertion.
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Affiliation(s)
- Ying Ying
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xian-Ju Lin
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Min-Juan Chen
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yan Cao
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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2
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Schaeffer CV, Cooke HL, Ghareeb PA. Radial Artery Reconstruction After Iatrogenic Cannulation-Related Occlusion: A Case Report. Cureus 2024; 16:e58214. [PMID: 38741851 PMCID: PMC11090679 DOI: 10.7759/cureus.58214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
A 59-year-old male, with a history of angiogram via the left radial artery during the workup for multi-trauma, presented to the hand clinic with a 14-day history of progressive critical ischemia in the left thumb and index finger, along with dry gangrene of the distal index fingertip. Radial artery occlusion was confirmed on imaging. The patient underwent radial artery thrombectomy, arterial reconstruction with vein graft, and amputation of the index fingertip. Postoperatively, perfusion to the thumb and index finger was restored, resulting in the resolution of associated pain and hypersensitivity. This case demonstrates the delayed presentation of ischemia following radial artery cannulation, which was successfully managed with radial artery thrombectomy and a saphenous vein graft.
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Affiliation(s)
- Christine V Schaeffer
- Department of Plastic and Reconstructive Surgery, University of Kentucky College of Medicine, Lexington, USA
| | - Hayden L Cooke
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Paul A Ghareeb
- Department of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, USA
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3
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Alabsi H, Goetz T, Murphy DT. Radial artery aneurysm secondary to dynamic entrapment by extensor pollicis longus tendon: a case of snapping thumb. Skeletal Radiol 2019; 48:971-975. [PMID: 30209540 DOI: 10.1007/s00256-018-3061-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Abstract
Aneurysms of the distal radial artery at the level of the wrist are rare. Most reported cases are posttraumatic, either from iatrogenic arterial puncture for radial arterial access or from a penetrating injury. Other causes include infection and connective tissue disorders. Early diagnosis is important to avoid the potential complications of thrombus formation, distal digital ischemia, and rupture. Evaluation of the radial artery is typically performed using non-invasive modalities like ultrasonography, computed tomographic angiography (CTA), and magnetic resonance angiography (MRA). Invasive angiography can also be performed, particularly if minimally invasive treatment options are being considered. We report a case of a 35-year-old male mechanic who presented with pain at the base of the left thumb dorsally, with reproducible painful snapping on dynamic exam. Ultrasound demonstrated a fusiform aneurysm of the radial artery. At the level of the aneurysm, there was dynamic entrapment of the artery between the extensor pollicis longus (EPL) tendon and the underlying trapezium. The patient's symptoms improved with conservative management and avoidance of the snapping-producing maneuvers. To our knowledge, this is the first published case of snapping at the base of the thumb resulting in repetitive entrapment of the radial artery by the EPL tendon captured on dynamic ultrasound examination.
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Affiliation(s)
- Hatim Alabsi
- Department of Radiology, St Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Thomas Goetz
- Department of Orthopaedic Surgery, St Paul's Hospital, Vancouver, BC, Canada
| | - Darra T Murphy
- Department of Radiology, St Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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4
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Hsueh SK, Cheng CI, Fang HY, Omran MM, Liu WH, Chung WJ, Chen CJ, Yang CH, Fang CY, Wu CJ. Feasibility and Safety of Transulnar Catheterization in Ipsilateral Radial Artery Occlusion. Int Heart J 2017; 58:313-319. [DOI: 10.1536/ihj.16-244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | | | - Wen-Hao Liu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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5
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Halbach J, Lowry D, Nelles M, Ayers J. Extensor pollicis longus tendon compression as the etiology of a true aneurysm of the radial artery in the anatomical snuff box. J Vasc Surg Cases Innov Tech 2016. [DOI: 10.1016/j.jvscit.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chitte SA, Veltri K, Thoma A. Ischemia of the hand secondary to radial artery thrombosis: A report of three cases. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 11:145-8. [PMID: 24115858 DOI: 10.1177/229255030301100308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Upper extremity arterial thrombosis, though rare, is more prevalent on the ulnar side of the circulation, with the most common etiology being repetitive blunt trauma to the hypothenar eminence. Radial artery thrombosis is even more rare and when it does occur, is associated most often with iatrogenic cannulation, producing subsequent thrombi and emboli. Three cases of spontaneous thrombosis of the radial artery extending to the superficial palmar arch and the princeps pollicis artery are presented here. Two patients underwent thrombectomies and one underwent excision of the thrombosed segment and reconstruction with a reversed saphenous vein graft. The etiology of the thrombus was consistent with cancer in two cases and trauma in one.
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Affiliation(s)
- Sachin A Chitte
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St Joseph's Healthcare; McMaster University, Hamilton, Ontario
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7
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Rademakers LM, Laarman GJ. Critical hand ischaemia after transradial cardiac catheterisation: an uncommon complication of a common procedure. Neth Heart J 2012; 20:372-5. [PMID: 22477649 DOI: 10.1007/s12471-012-0276-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We describe a case of critical hand ischaemia after transradial cardiac catheterisation. The patient presented with hand ischaemia 5 days after transradial coronary angiography. Urgent angiography demonstrated radial artery occlusion with embolisation to the palmar arch and digital arteries. The ischaemia was refractory to an extensive thrombolytic regimen, and subsequently, the patient was referred to the vascular surgeon for urgent thrombectomy and patch angioplasty. The patient recovered slowly and no amputation was necessary, but complaints of right hand numbness and paresthesia of all digits remained.
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Affiliation(s)
- L M Rademakers
- Department of Cardiology, Catharina-ziekenhuis, Michelangelolaan 2, 5623, EJ, Eindhoven, the Netherlands,
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8
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Rao SV, Bernat I, Bertrand OF. Remaining challenges and opportunities for improvement in percutaneous transradial coronary procedures. Eur Heart J 2012; 33:2521-6. [DOI: 10.1093/eurheartj/ehs169] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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9
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Lipira AB, Mackinnon SE, Fox IK. Axillary arterial catheter use associated with hand ischemia in a multi-trauma patient: case report and literature review. J Clin Anesth 2011; 23:325-8. [DOI: 10.1016/j.jclinane.2010.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 05/23/2010] [Accepted: 07/24/2010] [Indexed: 11/30/2022]
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10
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Roettges PS, Murray PM, Hill D. Hand gangrene following unsuccessful cannulation of the internal jugular vein: a case report and literature review. Hand (N Y) 2010; 5:206-9. [PMID: 19756870 PMCID: PMC2880673 DOI: 10.1007/s11552-009-9222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 08/19/2009] [Indexed: 11/25/2022]
Abstract
Hand gangrene following vascular cannula placement is uncommon and is usually the result of thrombotic occlusion of an artery. We describe a case of hand gangrene resulting in wrist disarticulation, following multiple unsuccessful attempts at internal jugular vein cannulation in a critically ill patient.
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Affiliation(s)
- Paul S. Roettges
- Neuroscience Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Peter M. Murray
- Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - David Hill
- Department of Family Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
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11
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Rhyne D, Mann T. Hand ischemia resulting from a transradial intervention: Successful management with radial artery angioplasty. Catheter Cardiovasc Interv 2010; 76:383-6. [DOI: 10.1002/ccd.22460] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Brzezinski M, Luisetti T, London MJ. Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesth Analg 2009; 109:1763-81. [PMID: 19923502 DOI: 10.1213/ane.0b013e3181bbd416] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.
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Affiliation(s)
- Marek Brzezinski
- Anesthesiology Service (129) VA Medical Center, 4150 Clement St., San Francisco, CA 94121, USA.
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13
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Feasibility and safety of antegrade radial artery cannulation. Eur J Anaesthesiol 2009; 26:207-12. [PMID: 19244691 DOI: 10.1097/eja.0b013e32831ac351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to compare thrombosis rates in antegrade (catheter directed toward the hand) versus retrograde (catheter directed toward the elbow) cannulation of the radial artery. Our secondary objectives were to compare these two techniques in terms of success rate, differences in noninvasive versus invasive blood pressure measurement and complications. METHODS After obtaining the approval of the local ethics committee and written informed consent, the patients were randomly allocated to the antegrade (group A, n=60) or retrograde (group R, n=60) groups. Arterial thrombosis was evaluated by ultrasonography in each patient. Noninvasive and invasive blood pressure measurements and complications were recorded. Data were analysed using Student's t-test, the Mann-Whitney U-test, the categorical chi test, Fisher's exact test and Bland-Altman analysis. RESULTS Thrombosis rates were similar between groups. The success rates for cannulation were 86.7 and 96.7% in the antegrade and retrograde groups, respectively (P<0.05). Complication rates were similar between groups. Very significant correlation was observed between the invasive and noninvasive methods when simultaneously measuring arterial systolic, diastolic and mean blood pressure. However, antegrade arterial measurements were consistently lower than those obtained via noninvasive methods. CONCLUSIONS We conclude that antegrade radial artery cannulation has no advantage over the retrograde approach in terms of reducing thrombosis, but it can be used in cases when the retrograde approach has failed.
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14
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Kryger ZB, Rawlani V, Dumanian GA. Treatment of chronic digital ischemia with direct microsurgical revascularization. J Hand Surg Am 2007; 32:1466-70. [PMID: 17996786 DOI: 10.1016/j.jhsa.2007.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 07/28/2007] [Accepted: 08/02/2007] [Indexed: 02/02/2023]
Abstract
The authors present their technique for treating digital ischemia using a radial-to-digital artery bypass graft performed in a bloodless field under tourniquet with the use of a microscope. The outcomes in 6 patients were resolution of fingertip ulcers, avoidance of more proximal amputations, and elimination of ischemic pain.
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Affiliation(s)
- Zol B Kryger
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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15
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Lin TL, Huang F, Chen CC, Shih HS, Hsieh CH. Multiple digital gangrene after a radial artery penetrating injury: a case report. Ann Vasc Surg 2007; 21:384-7. [PMID: 17419004 DOI: 10.1016/j.avsg.2006.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 06/21/2006] [Accepted: 06/21/2006] [Indexed: 10/21/2022]
Abstract
We describe the case of a young female patient who sustained a radial artery penetration injury from broken glass after falling and was managed only by external compression without arterial repair. Although the patient did not have any reported predisposing factors and the radial artery was normal as well as patent in the angiographic examination, she developed progressive multiple digital ischemia and required subsequent amputation of the gangrenous fingers. The possible mechanism might be an occlusion of the digital arteries originating from the injured radial artery by dispersion of thrombembolic particles distally during the injury as there was sparing of involvement of the ring finger, which wore a ring that restricted the thromboembolic particles from passing distally during the accident. This case revealed that particular attention should be paid to those patients with a radial artery penetration injury to facilitate early detection and implementation of therapy for possible finger ischemia and subsequent gangrene.
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Affiliation(s)
- Ting-Lung Lin
- Department of Plastic and Reconstructuve Surgery, Chang-Gung Memorial Hospital-Kaohsiung Medical Center, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan
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16
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Greenwood MJ, Della-Siega AJ, Fretz EB, Kinloch D, Klinke P, Mildenberger R, Williams MB, Hilton D. Vascular Communications of the Hand in Patients Being Considered for Transradial Coronary Angiography. J Am Coll Cardiol 2005; 46:2013-7. [PMID: 16325034 DOI: 10.1016/j.jacc.2005.07.058] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 06/29/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the accuracy of the Allen's test (AT) in predicting hand ischemia in patients undergoing transradial coronary angiography. BACKGROUND Patients with poor vascular communications between the radial artery (RA) and ulnar artery (UA), as indicated by an abnormal AT, are usually excluded from transradial coronary angiography to avoid ischemic hand complications. METHODS Over a four-month period, patients undergoing coronary angiography were screened for AT time. Circulation in the RA, UA, principal artery of the thumb (PAT), and thumb capillary lactate were measured before and after 30 min of RA occlusion. RESULTS Fifty-five patients were studied (20 normal, 15 intermediate, 20 abnormal). Three patients with an abnormal AT were excluded, owing to absence of detectible flow in the distal UA. Patients with an abnormal AT were all men, had a larger RA (3.4 vs. 2.8 mm; p <0.001), and smaller UA (1.9 vs. 2.5 mm; p <0.001), compared with patients with a normal AT. After 30 min of RA occlusion in patients with abnormal AT, blood flow to the PAT improved (3.2 to 7.7 cm/s; p <0.001) yet remained reduced relative to patients with normal AT (7.7 vs. 21.4 cm/s; p <0.001. Thumb capillary lactate was elevated in patients with an abnormal AT (2.0 vs. 1.5 mmol/l; p = 0.019). CONCLUSIONS After 30 min of RA occlusion, patients with an abnormal AT showed significantly reduced blood flow to the thumb and increased thumb capillary lactate (compared with patients with a normal AT) suggestive of ischemia. Transradial cardiac catheterization should not be performed in patients with an abnormal AT.
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Schindler E, Kowald B, Suess H, Niehaus-Borquez B, Tausch B, Brecher A. Catheterization of the radial or brachial artery in neonates and infants. Paediatr Anaesth 2005; 15:677-82. [PMID: 16029403 DOI: 10.1111/j.1460-9592.2004.01522.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In neonates and small children, percutaneous insertion of arterial catheters may be very difficult because of the small diameter of the arteries. Multiple attempts at cannulation are common and may be a predictor of serious adverse events following arterial cannulation. As an end artery, the brachial artery is usually not recommended for cannulation. However, limited data exist about brachial artery catheterization in neonates and young children. In this retrospective study, we report our experience with arterial indwelling catheters placed in neonates and small children prior to surgery for congenital heart defects. METHODS We reviewed 1473 patient medical files containing information about 1574 arterial lines for perioperative and intensive care monitoring. Patient data (age and weight), cannulation characteristics (site, type, percutaneous or cut down insertion), duration of catheterization and complications were documented using the anesthesia and/or intensive care unit files. Patients were divided into three groups according to body weight. Group I: patients with a bodyweight up to 5 kg (n = 561), group II: bodyweight 5-10 kg (n = 615), and group III: bodyweight 10-20 kg (n = 297). RESULTS The vast majority of our patients had radial or brachial artery catheterization. In group 1, we placed 200 brachial artery lines. Radial artery insertion was more successful with increasing body weight. Two 'cut downs' were necessary to place the arterial cannula (0.3%). The mean duration of the arterial cannula in place was 5.8 + 4.3 days in group I, which was significantly longer than in group III (2.9 + 2.2 days). Multiple attempts at catheter insertion were required for 200 patients in group I (P < 0.05 compared with groups II and III). The number of guide wires used was similar in all study groups. Generally, we preferred 24 and 22 G catheters for cannulation. Serious complications such as permanent ischemic damage were not observed. Temporary occlusion of an artery occurred in five of 1473 patients. The rate of local infection was 0.5% in group I, 0.7% in group II and 2.3% in group III. Local hematoma were observed more frequently, but with no relevant consequences. Most of our patients were cannulated on the right side. In group I, 112 brachial artery catheters were placed. The greater the weight, the more radial catheters were used compared with a brachial approach. The mean functional time of the catheters (5.8 +/- 4.3 days in group I) was significant shorter compared with patients from group III (2.9 +/- 2.2 days). In 33.3% (n = 200) multiple punctures were needed to place a catheter in group I (P < 0.05 compared with the other groups) whereas the use of a guide wire was evenly distributed throughout the study groups. Small catheters (24 and 22 G) were preferred for most patients. In total only eight 20 G sized catheters were used in the children of group III. CONCLUSIONS Even considering the nature of a retrospective study design, we conclude that the brachial artery could be considered for cannulation in neonates and small children.
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Affiliation(s)
- Ehrenfried Schindler
- Department of Anaesthesiology and Intensive Care Medicine, Asklepios Klinik Sankt Augustin, German Paediatric Heart Center, Sankt Augustin, Germany.
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18
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Valentine RJ, Modrall JG, Clagett GP. Hand Ischemia after Radial Artery Cannulation. J Am Coll Surg 2005; 201:18-22. [PMID: 15978439 DOI: 10.1016/j.jamcollsurg.2005.01.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Accepted: 01/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hand ischemia is a rare but potentially devastating complication of radial artery cannulation for arterial monitoring. The causes and ultimate outcomes of hand ischemia after radial artery cannulation are unclear. STUDY DESIGN My colleagues and I reviewed the clinical course of radial cannula-induced arterial thrombosis in eight patients during a recent 5-year period. RESULTS Mean (+/- SD) duration of radial artery ischemia was 3 +/- 2 days. Injuries were associated with advanced (grade IIb) ischemia that affected the entire hand in four patients and first three digits in the other four patients. Radial artery thrombosis was documented using noninvasive tests or arteriography in all patients. Five injuries were initially treated with thrombectomy and patch angioplasty (n = 4) or vein graft interposition (n = 1); two others were treated nonoperatively with vasodilators, and one was observed without treatment. Three of the four patch angioplasty repairs occluded within 24 hours. Regardless of patency, all patients who survived arterial repairs had continuing ischemia that resulted in digital gangrene or amputation. In contrast, gangrene developed in only one patient treated nonoperatively. CONCLUSIONS These data show that hand ischemia after radial artery cannulation is associated with high risk of tissue loss or amputation. Operative repair offered no advantage over nonoperative therapy in prevention of digital gangrene in this series. We hypothesize that digital gangrene results from distal embolization from the site of the initial arterial thrombosis, producing ischemia that is not remediated by radial artery revascularization. Nonoperative therapy with vasodilators can be equally effective in treating cannula-induced radial artery injuries in some patients.
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Affiliation(s)
- R James Valentine
- Division of Vascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9031, USA
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Abstract
Cannulation of the radial artery can result in complications ranging from arterial thrombosis, arterial aneurysm, compartment syndrome, infection, nerve injury, and skin necrosis to possible thumb or even hand necrosis if not recognized and treated early. The anatomy of the radial artery, the diagnosis of injury, and a treatment algorithm are presented so that potential devastating hand complications can be avoided.
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Affiliation(s)
- Steven G. Wallach
- Albert Einstein College of Medicine/Montefiore Medical Center, Lenox Hill Hospital, and Manhattan Eye, Ear, and Throat Hospital, New York, NY
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20
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Durie M, Beckmann U, Gillies DM. Incidents relating to arterial cannulation as identified in 7,525 reports submitted to the Australian incident monitoring study (AIMS-ICU). Anaesth Intensive Care 2002; 30:60-5. [PMID: 11939443 DOI: 10.1177/0310057x0203000111] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arterial cannulation is frequently used in the critical care environment. Literaturefocuses on insertion techniques and complications. This report utilized data from the Australian Incident Monitoring Study (AIMS-ICU) national database to identify common problems and contributing factors associated with the use and maintenance of arterial lines. A review of narratives, keywords and contributing factors yielded 251 reports outlining 376 incidents. Of these, 15% describing line insertion problems, 66% line use and maintenance problems and 19% patient injuries. Inadequate line securing, accidental line dislodgement, incorrect set-up, distal ischaemia and infection featured prominently. As a result of the incident, 49% of patients involved suffered no ill effect, 28% minor physiological complications and 15% suffered major adverse effects. Multiple contributing factors were selected for each report, with lack of knowledge, rule-based errors, high unit activity, and lack of support staff or supervision selected most frequently. This study highlights the need to employ meticulous insertion technique, line set-up, securing, frequent line assessment and the early removal of lines no longer essential to patient care. Support and education of staff as well as the development of protocols are important for the safe use of arterial lines.
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Affiliation(s)
- M Durie
- Department of Anaesthesia, Intensive Care, Pain Management, John Hunter Hospital, Newcastle, New South Wales
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Green JA, Tonkin MA. Ischaemia of the Hand in Infants Following Radial or Ulnar Artery Catheterisation. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 1999; 4:151-157. [PMID: 11089173 DOI: 10.1142/s0218810499000216] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/1999] [Accepted: 07/30/1999] [Indexed: 11/18/2022]
Abstract
Radial and ulnar arterial catheterisation have become frequently used methods of monitoring in neonatal and pediatric intensive care units. Minor complications are common and temporary ischaemic changes in the form of blanching are well described. However, permanent ischaemia in the infant has rarely been reported. This series is the first in the hand surgery literature to address the issue of digital ischaemia following radial artery catheterisation in the infant population and adds three to the six previously reported cases in the English literature. One patient had fingertip necrosis to the distal interphalangeal joint level of the middle, ring and little fingers, while two other patients required amputation at the carpometacarpal joint level.
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Affiliation(s)
- JA Green
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital and Royal Alexandra Hospital for Children, University of Sydney, Sydney, Australia
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22
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Longo GM, Friedman AC, Hollins RR, Buresh CJ, Baxter BT. Distal radial artery lesion as a source of digital emboli. J Vasc Surg 1998; 28:710-4. [PMID: 9786269 DOI: 10.1016/s0741-5214(98)70099-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ischemic changes of the digits caused by emboli are rare. When they do occur, the typical sites of origin include the heart, the proximal subclavian artery, and the thoracic outlet. Dialysis access or iatrogenic injuries may be a more distal source of emboli. Two patients, each with embolization to the thumb and index finger from a lesion in the anatomical snuff-box, were studied. Neither patient had any other atherosclerotic occlusive disease, and both lesions occurred precisely where the extensor pollicis longus crossed the artery and would be expected to compress it against the proximal epiphysis of the first metacarpal when the hand was closed. These lesions were excised, and bypass was performed, with rapid resolution of symptoms. This is an unusual cause of digital embolization that should be considered in patients with emboli to the thumb and index finger.
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Affiliation(s)
- G M Longo
- Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280, USA
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Dumanian GA, Segalman K, Mispireta LA, Walsh JA, Hendrickson MF, Wilgis EF. Radial artery use in bypass grafting does not change digital blood flow or hand function. Ann Thorac Surg 1998; 65:1284-7. [PMID: 9594852 DOI: 10.1016/s0003-4975(98)00176-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient selection criteria have not been clearly established for use of the radial artery as a bypass conduit. To help establish such criteria, we measured changes in digital blood flow and hand function after radial artery removal. METHODS Ninety-eight patients of the first 122 consecutive patients considered for radial artery harvest met predetermined criteria by vascular noninvasive studies to undergo removal of the radial artery. In 42 of these 98 patients, the radial artery was actually used as a bypass conduit; 28 of these 42 patients returned for noninvasive vascular studies, a critical review of hand function, and a hand symptom questionnaire. RESULTS There were no significant differences between the operated and nonoperated hands for digital-brachial indices, cold response, grip or pinch strength, digital two-point discrimination, or nine-hole peg tests. The patients had an increased incidence of a small amount of forearm numbness and tingling, but no increase of pain or cold intolerance. CONCLUSIONS For properly selected patients, there are minimal changes in hand function after radial artery removal.
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Affiliation(s)
- G A Dumanian
- Raymond Curtis Hand Center, Union Memorial Hospital, Baltimore, Maryland, USA
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