Iatrogenic Radial Artery Injuries: Variable Injury Patterns, Treatment Times, and Outcomes

Abstract

Background: The radial artery is commonly accessed for arterial blood sampling, invasive blood pressure monitoring, and vascular access for cardiac catheterization. Iatrogenic radial artery injury is a rare complication with potentially devastating outcomes. The purpose of our study was to identify the timing of these injuries and define a treatment algorithm. Methods: A retrospective chart review of all patients with iatrogenic radial artery injuries were identified between the years 2008 and 2018. Patient demographics, mechanism of injury, interventions, and outcomes were recorded. Results: A total of 18 patients were identified with iatrogenic radial artery injury over a 10-year period. Fifty percent of these resulted from arterial line cannulation, and 50% occurred after transradial cardiac catheterization. Thirty-three percent resulted in radial artery pseudoaneurysm (RAP), and 66% had acute radial artery thrombosis (RAT). Eleven of the 18 patients underwent operative intervention. Of the 12 patients with RAT, 4 were treated with systemic anticoagulation for 3 months. All patients with RAP who were surgically treated had resolution of symptoms on follow-up evaluation. Of the patients with RAT, 2 had persistent sensorimotor deficits after treatment, and 1 patient had multiple necrotic fingers requiring amputation. Conclusion: Radial artery injuries are an uncommon but potentially devastating complication of common invasive procedures resulting in thrombosis, pseudoaneurysm, or overt hand ischemia. The treatment options vary depending on presenting symptoms.

Society of Interventional Radiology Quality Improvement Standards on Radial Artery Access

“…Digital ischemia. Insufficient flow of oxygenated blood to the digits with the risk of necrosis and subsequent iatrogenic or autoamputation (54)(55)(56).…”

Bivalirudin vs. Heparin on Radial Artery Thrombosis during Transradial Coronary Intervention: An Optical Coherence Tomography Study

“…As a result, there is a chance that the incidence of RAT during TRI has been underestimated in previous studies. For example, data from ACUITY and SWITCH III trials showed that no device-associated thrombus could be documented under routine angiography [ 26 , 27 ]. Currently, OCT has shed light on the assessment of intravascular thrombus and evaluating efficacy of antithrombotic drugs in vivo [ 2 ], and it is reasonable that growing evidence for intraprocedure thrombosis will draw attention in the future.…”

Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma

“…48 Complications related to radial access are rare, but potentially devastating and include radial artery pseudoaneurysm formation or acute radial artery thrombosis with subsequent hand ischemia. 49 The role of the interventionalist in these settings is limited; treatment options following iatrogenic radial artery injury typically consist of anticoagulation and surgical intervention. 49 Errant placement of large bore (>7 Fr) central venous catheters is another common cause of iatrogenic arterial injury.…”

“…49 The role of the interventionalist in these settings is limited; treatment options following iatrogenic radial artery injury typically consist of anticoagulation and surgical intervention. 49 Errant placement of large bore (>7 Fr) central venous catheters is another common cause of iatrogenic arterial injury. Inadvertent placement of these catheters into arteries complicates 0.1 to 8% of attempted central line placements.…”