Weinberg Laurence, Abu-Ssaydeh Diana, Spanger Manfred, Lu Patrick, Li Michael H-G
Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia; Department of Surgery, University of Melbourne, Austin Health, Victoria, 8002, Australia.
Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
Int J Surg Case Rep. 2018;42:269-273. doi: 10.1016/j.ijscr.2017.12.034. Epub 2017 Dec 27.
Brachial arterial catheters provide a more accurate reflection of central aortic arterial pressure compared to their radial counterparts. Although brachial arterial line complications are uncommon, we report a case of a rare iatrogenic brachial artery dissection with complete anterograde occlusion from elective arterial line placement.
A 41-year-old female presented for a right upper and middle lobe resection of a large neuroendocrine lung cancer. A brachial arterial line was inserted for continuous blood pressure monitoring using clinical landmarks. Six hours postoperatively the left hand was noted to be pale, cool and pulseless with complete paraesthesia. Thrombus was initially suspected on computed tomography angiography. Upon return to theatre, extensive dissection of the posterior brachial arterial wall was identified.
We review our diagnostic pathway and treatment of this rare complication. Recommendations to minimise the risks of complications from brachial arterial line insertion are also overviewed. We recommend the routine utilization of ultrasound-guided technique and regular post-insertion neurovascular monitoring for the prevention and early recognition of complications from brachial artery catheter insertion.
与桡动脉导管相比，肱动脉导管能更准确地反映中心主动脉压。尽管肱动脉置管并发症并不常见，但我们报告了一例罕见的医源性肱动脉夹层，因择期动脉置管导致完全性顺行性闭塞。
一名41岁女性因右肺上叶和中叶的大型神经内分泌肺癌行切除术。通过临床标志插入肱动脉导管进行连续血压监测。术后6小时，发现左手苍白、冰冷且无脉搏，伴有完全性感觉异常。计算机断层血管造影最初怀疑有血栓形成。返回手术室后，发现肱动脉后壁广泛夹层。
我们回顾了对这一罕见并发症的诊断途径和治疗方法。还概述了将肱动脉置管并发症风险降至最低的建议。我们建议常规使用超声引导技术，并在置管后定期进行神经血管监测，以预防和早期识别肱动脉导管插入的并发症。
