Extremity Amputation following Radial Artery Cannulation in Two Patients with Craniotomy

Song, Sun Ok; Lee, Keung Sook; Kim, Heung Dae

Abstract

Percutaneous radial artery cannulation is a very useful method of invasive monitoring in critically ill patients. Although the method is generally safe and simple, it can infrequently lead to tissue necrosis. Recently we experienced this complication in two patients. The first patient was a 52-year-old male who received a craniotomy for removal of a subdural hematoma. Right radial artery cannulation was carried out after a modified Allen's test appeared to be positive. After removal of the cannula on the 9th hour after operation because it was obstructed, his right hand was cool and cyanotic. Despite stellate ganglion block and other supportive therapy, the ischemic changes increasingly worsened. On the 10th day after removal of the cannula, the necrotic change was extended in all fingers of the right hand and he underwent disarticulation of the right wrist. The second patient was a 63-year-old female who received a craniotomy for clipping of a cerebral aneurysm. Left radial artery cannulation was performed without a modified Allen's test. On the 2nd hour after operation, the cannula was removed because the left hand was cyanotic. On Doppler examination, the radial and ulnar arteries were not identified with blood flow. On angiographic finding, the radial artery was occluded almost totally and the ulnar artery was not visualized below the antecubital fossa. After the left stellate ganglion block, thrombectomy and anticoagulant therapy, the ischemia in the left hand was transiently improved, but then became more aggravated and eventually the level of tissue necrosis advanced to the left elbow, therefore amputation above the left elbow joint was performed. Presumptive causes of these tissue necroses were peripheral embolization in the first patient, and inadequate collateral circuation of the ulnar arterial malformation in the second case.