Ischemic Injury following Uncomplicated Radial Artery Catheterization

The use of indwelling arterial catheters has become increasingly widespread in pediatric patients in recent years. As experience has expanded so has awareness of the complications that their use may entail. We report a case of a 9-month-old patient with Reye's syndrome who suffered diffuse microvascular compromise, which resulted in partial loss of an extremity following radial artery catheterization. CASE REPORT A 9-month-old male infant, previously in excellent health, was seen with a three-day history of rhinorrhea and cough, a one-day history of vomiting, and a 12-hour history of lethargy. When seen at a local hospital he had status left-sided focal seizures and a serum glucose of 17 mg/100 ml.

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Acute Arterial Ischemia in a Neonate: Complication of an Indwelling Radial Artery Catheter

Journal of Neonatology ◽

10.1177/0973217918794997 ◽

2018 ◽

Vol 32 (2-3) ◽

pp. 67-70

Author(s):

Harshil Anurag Patel ◽

Amee Atulkumar Amin ◽

Dipen Vasudev Patel ◽

Somashekhar Marutirao Nimbalkar

Keyword(s):

Unfractionated Heparin ◽

Radial Artery ◽

Perinatal Depression ◽

Surgical Intervention ◽

Full Term ◽

Clinical Monitoring ◽

Term Newborn ◽

Radial Artery Catheterization ◽

Left Radial Artery ◽

Radial Artery Catheter

A full-term newborn with perinatal depression, meconium stained liquor, shock, and hypoglycemic seizures was admitted at a hospital after 70 hours of life. He was ventilated, received antibiotics, and vasopressors. After 8 hours of left radial artery catheterization, ischemic changes appeared on tips of all the fingers of the newborn. The catheter was removed, and intravenous unfractionated heparin was started. Arterial Doppler revealed thrombus in both radial and ulnar arteries. The case was of category III (irreversible) acute arterial ischemia. Review Doppler after 4 days showed low resistance and dampened flow in radial and ulnar arteries. Surgical intervention was not done. Aspirin was given at discharge, and at 40 days, the distal end of the metacarpals was affected. The positive modified Allen’s test and close clinical monitoring did not guarantee the safety of radial artery catheterization. Other measures need to be critically evaluated to identify evolving thrombus early.

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Radial artery catheterization of critically ill patients in the emergency department

Annals of Emergency Medicine ◽

10.1016/s0196-0644(89)80741-3 ◽

1989 ◽

Vol 18 (4) ◽

pp. 463

Author(s):

GF Bachhuber ◽

DW Plummer ◽

M Lutze ◽

E Ruiz

Keyword(s):

Emergency Department ◽

Critically Ill ◽

Radial Artery ◽

Critically Ill Patients ◽

Radial Artery Catheterization

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Navigating a proximal loop in the radial artery and avoiding the recurrent radial artery

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015712 ◽

2020 ◽

Vol 12 (7) ◽

pp. 724-724 ◽

Cited By ~ 2

Author(s):

Rimal Dossani ◽

Muhammad Waqas ◽

Michael K Tso ◽

Gary B Rajah ◽

David E Smolar ◽

...

Keyword(s):

Radial Artery ◽

Chronic Subdural Hematoma ◽

Anatomical Variations ◽

Middle Meningeal Artery ◽

Conventional Technique ◽

Artery Embolization ◽

Transradial Approach ◽

Road Map ◽

Radial Artery Catheterization ◽

Meningeal Artery

Several anatomical variations of the radial artery have been described in the literature. Common variations include radial artery loop, recurrent branch, and anastomotic channels connecting the radial and brachial arteries. These variations can pose significant technical challenges to safe radial artery catheterization. Because radial access for neurointervention is becoming popular, appreciation of these variations and mastery of techniques for safe radial artery catheterization are of paramount importance. In this operative video,(video 1) we present a case of a 75-year-old man who underwent middle meningeal artery embolization for treatment of chronic subdural hematoma using a transradial approach. The patient was found to have a radial artery loop and a recurrent branch off the radial artery. The loop could not be negotiated with the conventional technique. We therefore used a microcatheter system with a stiff microwire to navigate and straighten the radial loop under road map guidance. The remaining procedure was performed successfully.

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