Iatrogenic Radial Artery Injuries: Variable Injury Patterns, Treatment Times, and Outcomes
Chase A Arbra, MD; Jon Simon Ivey, MD; Fernando Herrera, MD
University of South Carolina, Charleston, SC
Introduction Hand ischemia as a result of radial artery catheterization, performed for either invasive blood pressure monitoring or cardiac catheterization, is a rare but devastating complication. The injury patterns, diagnostic modalities and treatment decisions have not been well characterized in the literature. Our objective was to identify those patients with complications from radial artery access and determine an algorithmic approach to management of these complex problems.
Materials and Methods A retrospective chart review was performed to identify patients 18 years of age or older from 2006-2016 with iatrogenic radial artery injuries. Those with traumatic injuries and brachial or axillary artery injuries were excluded. Data was collected on patient demographics, diagnosis, timing of presentation (acute vs chronic), mechanism of injury, diagnostic imaging utilized, type and timing of intervention, and long-term hand function. Statistical analysis was performed, using a p-value of 0.05 for significance.
Results Eighteen patients were identified in the 10-year study period, with a median age of 62.5 [49.8,68.8] years. There were 12 (67%) radial artery thromboses and 6 (33%) pseudoaneurysms. Nine cases (50%) occurred following cardiac catheterization, while the other nine were after arterial line insertion. Fourteen patients presented with acute symptoms. Eleven patients (61%) required surgical intervention. Of the patients with acute thrombosis (11), 7 had signs of hand ischemia (64%). All but one patient with signs of hand ischemia underwent urgent surgical intervention (thrombectomy/repair of radial artery or radial artery resection and vein grafting). One patient (5.6%) underwent radiocarpal amputation due to late presentation. Treatment decisions stratified by injury type can be seen in Table 1. None of the patients with pseudoaneurysms had any long-term hand dysfunction, compared to two thrombosis patients: one amputation, one patient with persistent median neuropathy.
Conclusions Radial artery iatrogenic injuries are rare, but may be associated with significant morbidity if perfusion is compromised. Treatment is determined by injury type and presence of hand ischemia.
Table 1: Management of Iatrogenic Radial Artery Injuries, by Injury Type
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