Phong T. Dargon, Timothy K. Liem, Margaret C. Gorman, Amir F. Azarbal, Erica L. Mitchell, Gregory J. Landry, Gregory L. Moneta
Oregon Health & Science University, Portland, OR.
OBJECTIVES: Radial artery catheterization may be complicated by arterial thrombosis and hand ischemia. We sought to identify risk factors for radial catheter-associated ischemic hand complications and need for operative intervention.
METHODS: All patients with radial artery catheter-associated ischemic hand complications at a single hospital between 2006 and 2011 were identified. Clinical risk factors (vascular comorbidities, anticoagulation or antiplatelet therapy, shock, sepsis, and APACHE score) in patients whose complications lead to surgical consultation, were compared with an age- and gender-matched control patient cohort with uncomplicated radial artery catheters. Nominal variables were compared using McNemar test, chi-square, and fisher’s exact test (p<.05). Paired t-test and one-way ANOVA were used for continuous variables.
RESULTS: There were 23 consultations performed for hand ischemia related to radial artery catheters. Compared to nonischemic controls consulted patients were more likely to have shock (p=.002), sepsis (p=.01), and be receiving anticoagulation (p=.04). Twelve patients (52%) required surgical revascularization; thrombectomy (91.7%), intraoperative thrombolysis (58.3%), vein patch angioplasty (33.3%), and intraoperative angiography (50%). In patients who underwent revascularization, 2 required digital amputation, 1 required major upper extremity amputation, and 2 patients died. In patients who underwent nonoperative management, none required amputation. Overall mortality was 22% in patients requiring vascular consultation and 17% in those requiring operation for radial artery catheter ischemic complications.
CONCLUSIONS: Fifty-two percent of patients with ischemic complications of radial artery catheters require operation and mortality is high. Patients with shock and sepsis are more likely to develop radial catheter-associated upper extremity ischemia. Those requiring revascularization have a high rate of digital or major upper extremity amputation.
AUTHOR DISCLOSURES: A. F. Azarbal, Nothing to disclose; P. T. Dargon, Nothing to disclose; M. C. Gorman, Nothing to disclose; G. J. Landry, Nothing to disclose; T. K. Liem, Nothing to disclose; E. L. Mitchell, Nothing to disclose; G. L. Moneta, Nothing to disclose.
Posted April 2012