Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
J Vasc Surg. 2013 Nov;58(5):1325-30. doi: 10.1016/j.jvs.2013.05.011. Epub 2013 Jun 27.
Cannulation of the radial artery is frequently performed for invasive hemodynamic monitoring. Complications arising from indwelling catheters have been described in small case series; however, their surgical management is not well described. Understanding the presentation and management of such complications is imperative to offer optimal treatment, particularly because the radial artery is increasingly accessed for percutaneous coronary interventions.
We conducted a retrospective review to identify patients who underwent surgical intervention for complications arising from indwelling radial artery catheters from 1997 to 2011.
We identified 30 patients who developed complications requiring surgical intervention. These complications were categorized into ischemic and nonischemic, with 15 patients identified in each cohort. All patients presenting with clinical hand or digital ischemia underwent thrombectomy and revascularization. Complications in the nonischemic group included three patients with deep abscesses with concomitant arterial thrombosis, two with deep abscesses alone, and 10 with pseudoaneurysms. Treatment strategy in this group varied with the presenting pathology. Among the entire case series, three patients required reintervention after the initial surgery, all in individuals initially presenting with ischemia who developed recurrent thrombosis of the radial artery. There were no digital or hand amputations in this series. However, the overall in-hospital mortality in these patients was 37%, reflecting the severity of illness in this patient cohort. Three patients who were positive for heparin-induced thrombocytopenia antibody had 100% mortality compared with those who were negative (P = .04, Fisher exact test). In-hospital mortality was higher in patients presenting with initial ischemia than in those with nonischemic complications (53% vs 20%; P = .06). Among 10 patients who presented with pseudoaneurysms, five (50%) were septic at presentation with positive blood cultures, and six (60%) had positive operating room cultures. Staphylococcus aureus was identified as the causative organism in all of these patients.
Complications of radial artery cannulation requiring surgical intervention can represent infectious and ischemic sequelae and have the potential to result in major morbidity, including digital or hand amputation and sepsis, or death. Although surgical treatment is successful and often required in these patients to treat severe hand ischemia, hemorrhage, or vascular infection, these complications tend to occur in critically ill hospitalized patients with an extremely high mortality. This must be taken into consideration when planning surgical intervention in this patient cohort. Finally, radial arterial cannulation sites should not be overlooked when searching for occult septic sources in critically ill patients.
桡动脉插管常用于有创血流动力学监测。已有小病例系列报道留置导管引起的并发症；然而，其手术治疗方法并不完善。了解此类并发症的表现和处理方法对于提供最佳治疗至关重要，尤其是因为桡动脉越来越多地用于经皮冠状动脉介入治疗。
我们进行了一项回顾性研究，以确定 1997 年至 2011 年间因留置桡动脉导管引起并发症而接受手术干预的患者。
我们确定了 30 名出现并发症需要手术干预的患者。这些并发症分为缺血性和非缺血性两类，每组各有 15 名患者。所有出现手部或手指缺血临床症状的患者均接受了血栓切除术和血运重建术。非缺血性并发症组包括 3 名伴有动脉血栓形成的深部脓肿患者，2 名单纯深部脓肿患者和 10 名假性动脉瘤患者。该组的治疗策略因发病机制而异。在整个病例系列中，3 名初始手术治疗后需要再次干预的患者均为最初表现为缺血，继而发生桡动脉再发性血栓形成的患者。本系列中无手指或手部截肢。然而，这些患者的总体院内死亡率为 37%，反映了该患者群体的疾病严重程度。3 名肝素诱导血小板减少抗体阳性的患者死亡率为 100%，而抗体阴性的患者死亡率为 0（P =.04，Fisher 确切检验）。与非缺血性并发症患者相比，最初表现为缺血的患者的院内死亡率更高（53% vs 20%；P =.06）。在 10 名出现假性动脉瘤的患者中，5 名（50%）患者就诊时即伴有脓毒症，血培养阳性，6 名（60%）手术室培养阳性。所有这些患者的病原体均为金黄色葡萄球菌。
需要手术干预的桡动脉插管并发症可表现为感染性和缺血性后遗症，有可能导致严重的发病率，包括手指或手部截肢、败血症或死亡。虽然这些患者通常需要手术治疗以治疗严重的手部缺血、出血或血管感染，但这些并发症往往发生在患有极高死亡率的重症住院患者中。在为该患者群体制定手术干预计划时，应考虑到这一点。最后，在寻找重症患者隐匿性感染源时，不应忽视桡动脉插管部位。
