Abstract
We present a case of ischaemic hand injury in a patient, who had 95% occlusion of both the ulnar and radial arteries, after atraumatic placement of a left radial artery catheter. The presence of cigarette burns on the dorsum of the hand was highly suggestive of vascular compromise. There were no signs of vascular compromise after placement of the arterial line which was removed 24 hr later. Ten days after placement the patient complained of pain with ensuing ischaemic changes resulting in necrosis of the finger tips and eventual amputation of the hand. We recommend using other sites of arterial access such as axillary or superficial temporal artery in patients with severe peripheral vascular disease.
Résumé
Nous présentons un cas de lésion ischémique de la main survenue chez un patient qui a developpé une occlusion à 95% des artères radiales et cubitales après l’insertion atraumatique d’une canule radiale gauche. La présence de brûlures de cigarettes sur le dos de la main suggérait déjà une atteinte vasculaire. On n’pas noté de signes d’ischémie après l’installation de la canule qui fut retirée après 24 heures. Dix jours après l’insertion, le patient s’est plaint d’une doubleur suivie de changements ischémique évoluant vers une nécrose du bout des doigts et d’une amputation. Nous recommandons l’utilisation d’accès artériels différents comme les artères temporales superficielles ou axillaires chez les porteurs de maladies vasculaires périphériques.
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Cannon BW, Meshier WT. Extremity amputation following radial artery cannulation in a patient with hyperlipo-proteinemia type V. Anesthesiology 1982; 56: 222–3.
Mangano DT, Hickey RF. Ischaemia injury following uncomplicated radial artery catheterization. Anesth Analg 1979; 58: 55–7.
McCready RA, Hyde GL, Bivins BA, Hagihara PF. Brachial artery puncture: a definitive risk to the hand. South Med J 1984; 77: 786–9.
Evans PJ, Kerr JH. Arterial occlusion after cannulation. BMJ 1975; 3: 197–9.
Johnson FE, Sumner DS, Strandness DE. Extremity necrosis caused by indwelling arterial catheters. AM J Surg 1976; 131: 375–9.
Vender JS, Watts DR. Differential diagnosis of hand ischemia in the presence of an arterial cannula. Anesth Analg 1982; 61: 465–8.
Slogoff S, Keats AS, Arlund C. On the safety of radial artery cannulation. Anesthesiology 1983; 59: 42–7.
Baker RJ, Chunprapaph B, Nyhus LM. Severe ischemia of the hand following radial artery catheterization. Surgery 1976; 80: 449–57.
Mandel MA, Dauchot PJ. Radial artery cannulation in 1,000 patients: precautions and complications. J Hand Surg [AM] 1977; 2: 482–5.
Kim JM, Arakawa K, Bliss J. Arterial cannulation: factors in the development of occlusion. Anesth Analg 1975; 54: 836–41.
Downs JB, Rackstein AD, Klein EF Jr,Hawkins IF Jr. Hazards of radial-artery catheterization. Anesthesiology 1975; 38: 283–6.
Gauer PK, Downs JB. Complications of arterial catheterization. Respiratory Care 1982; 27: 435–44.
Allen EV. Thromboangiitis Obliterans: methods of diagnosis of chronic occlusive arterial lesions distal to the wrist with illustrative cases. Am J Med Sci 1929; 178: 237–44.
Palm T. Evaluation of peripheral arterial pressures on the thumb following radial artery cannulation. Br J Anaesth 1977; 49: 819–24.
Bedford RF. Radial artery function following percutaneous cannulation with 18- and 20-gauge catheters. Anesthesiology 1977; 47: 37–9.
Brown AE, Sweeney DB, Lumley J. Percutaneous radial artery cannulation. Anaesthesia 1969; 24: 532–6.
Fogarty TJ, Krippaehne WW. Vascular occlusion following arterial catheterization. Surg Gynecol Obstet 1965; 121: 1295–7.
Bedford RF, Wollman H. Complications of percutaneous radial-artery cannulation: an objective prospective study in man. Anesthesiology 1973; 38: 228–36.
Hurwitz RA, Franken EA Jr.,Girod DA, Smith JA, Smith WL. Angiographic determination of arterial patency after percutaneous catheterization in infants and small children. Circulation 1977; 56: 102–5.
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Mangar, D., Laborde, R.S. & Vu, D.N. Delayed ischaemia of the hand necessitating amputation after radial artery cannulation. Can J Anaesth 40, 247–250 (1993). https://doi.org/10.1007/BF03037036
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DOI: https://doi.org/10.1007/BF03037036