Valentine R James, Modrall J Gregory, Clagett G Patrick
Division of Vascular Surgery, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9031, USA.
J Am Coll Surg. 2005 Jul;201(1):18-22. doi: 10.1016/j.jamcollsurg.2005.01.011.
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.
My colleagues and I reviewed the clinical course of radial cannula-induced arterial thrombosis in eight patients during a recent 5-year period.
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.
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.
手部缺血是桡动脉置管进行动脉监测时一种罕见但可能具有毁灭性的并发症。桡动脉置管后手部缺血的原因及最终结局尚不清楚。
我和同事回顾了最近5年8例桡动脉置管引起的动脉血栓形成患者的临床病程。
桡动脉缺血的平均（±标准差）持续时间为3±2天。损伤与严重（IIb级）缺血相关，4例患者整个手部受累，另外4例患者累及前三个手指。所有患者均通过无创检查或血管造影证实存在桡动脉血栓形成。5例损伤最初接受了血栓切除术和补片血管成形术（4例）或静脉移植术（1例）治疗；另外2例采用血管扩张剂进行非手术治疗，1例未接受治疗。4例补片血管成形术修复中有3例在24小时内闭塞。无论血管是否通畅，所有动脉修复术后存活的患者均持续存在缺血，导致手指坏疽或截肢。相比之下，非手术治疗的患者中只有1例发生坏疽。
这些数据表明，桡动脉置管后手部缺血与组织丢失或截肢的高风险相关。在本系列中，手术修复在预防手指坏疽方面并不比非手术治疗更具优势。我们推测手指坏疽是由最初动脉血栓形成部位的远端栓塞引起的，导致缺血，而桡动脉血运重建无法修复。在某些患者中，使用血管扩张剂的非手术治疗在治疗置管引起的桡动脉损伤方面同样有效。
