Acute reversible hand ischemia after radial artery cannulation

Excerpt

An 83-yr-old woman was scheduled for maxillectomy and free flap reconstruction for carcinoma. Her past medical history included hypertension, gastroesophageal reflux, and osteoarthritis. She was not taking any anti-platelet/anticoagulant agents and denied previous cerebrovascular and/or peripheral vascular disease. Uneventful (i.e., first-pass) cannulation (20G, 4.45 cm long Arrow® catheter with an integrated 0.46 mm diameter Seldinger guide wire; Teleflex Medical, Athlone, Ireland) of her right radial artery was performed using palpation under local infiltration of 1 mL plain lidocaine 2% using a 30G hypodermic needle. Five minutes later, she reported rapidly progressive right-hand paresthesia and exhibited painless pallor (Figure, panel A). Despite a normal pulse oximetry tracing (98%) on her right index finger, the arterial catheter was removed, resulting in rapid resolution of the symptoms and pallor (Figure, panels B-D). Subsequent ultrasound (US) examination of the 2-mm diameter artery showed no apparent sign of spasm, thrombosis, dissection, or surrounding hematoma. Surgery proceeded uneventfully with no postoperative issues noted regarding her hand circulation and/or the neurologic examination.

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