Original scientific article
Hand Ischemia after Radial Artery Cannulation

https://doi.org/10.1016/j.jamcollsurg.2005.01.011Get rights and content

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.

Section snippets

Methods

We reviewed the records of all patients presenting to the vascular surgery service with acute hand ischemia after radial artery cannulation between July 1999 and June 2004. These patients were indexed from the institutional operative database, the vascular morbidity and mortality registry, and records of vascular surgery consultations during the study period. Subjects without a clear history of radial artery cannulation for hemodynamic monitoring (eg, patients undergoing transradial cannulation

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Cited by (81)

  • Complications of Transradial Catheterization and Cannulation

    2019, Journal of Hand Surgery
    Citation Excerpt :

    Although vasodilators and anticoagulation can prevent RAO, there is insufficient evidence to support their independent use in the treatment of RAO. Valentine et al12 reported on a patient with acute RAO and spasms of the ulnar, palmar, and interosseous arteries, which were treated successfully with intra-arterial verapamil. Another patient in this series experienced some improvement of ischemia symptoms after oral nifedipine treatment for acute RAO.

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Competing Interests Declared: None.

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