Management and Outcome of Surgical Treatment for Complications of Indwelling Radial Arterial Catheters

Objectives: Radial artery (RA) cannulation for hemodynamic monitoring in critically ill can resullt in rare, but significant morbidity. We review presentation, management, and outcome of radial catheter complications that required surgical intervention.
Methods: A retrospective review of 25 patients, undergoing surgery for RA line complications between 1997 and 2006.
Results: Patient risk factors were: diabetes (20%), CAD (56%), HIT (12%), pressor support (16%). The most common presentation were hand ischemia (52%), bacteremia (36%), pulsatile mass (28%), radial artery rupture (8%). Diagnoses included thrombosis (n=12, 48%), pseudoaneurysms (n=8, 32%), abscess (n=4,16%). Operative procedures included: 16 repairs (64%), 8 ligations (32%), and 1 I&D alone (4%). 40.9% of operative cultures revealed S.aureus and were more frequently positive with pseudoaneurysms than with thrombosis (55.6% vs. 18.2%, p=.15, Fisher's test). Of patients with pseudoaneurysms, 4 of 9 were bacteremic (44.4%), including 2 patients with RA rupture. Two patients (15%) with RA thromboses required repeat thrombectomy for recurrent ischemia. There were no amputations or major surgical complications related to the procedures. Overall in-hospital mortality was 40.9%. Symptomatic patients were more likely to die on the same hospitalization than patients with pseudoaneurysms (63.6% vs. 22.2%, p=.09, Fisher's test). HIT patients (n=3) had 100% mortality.
Conclusions: Complications of RA cannulation can result in major morbidity. Surgical treatment when required had a high success rate in this cohort. Extremely high mortality in these critically ill patients must be considered when planning intervention. RA line sites should not be overlooked when searching for occult septic sources in critically ill.