Long-term brachial artery catheterization: ischemic complications.
The brachial artery is not used for long-term catheterization and routine hemodynamic monitoring because a high incidence of ischemic complications is anticipated. However, in a review of 157 patients who had 225 percutaneous transbrachial hepatic artery catheters placed for infusion of chemotherapeutic agents, catheters remained in situ from 1 day to 14 months (median 68 days). One hundred seventy-three catheters (77%) were removed electively and 52 catheters (23%) were removed because of complications. Diminution or loss of the radial pulses occurred on insertion of 88 catheters (39.1%) and 16 of these (8%) were removed after 24 hours because ischemic symptoms developed. Subsequently, 25 other catheters (11.1%) were removed because of complications such as paresthesia, eight (3.5%); brachial artery thrombosis, four (1.7%); microembolization, three (1.3%); claudication, two (0.8%); and pseudoaneurysm, one (0.4%). Seven catheters (3.1%) were removed because of a combination of pallor, diminished pulses, and muscle weakness. Hemorrhage from the arteriotomy site necessitated the removal of 11 other catheters (4.9%). Amputation, ischemic ulceration, major neuromuscular sequelae, and peripheral embolization to the head or lower limbs did not occur. This study suggests that long-term brachial artery catheterization is associated with a low incidence of permanent ischemic complications.
Moran
K T
KT
Section of Peripheral Vascular Surgery, Lahey Clinic Medical Center, Burlington, MA 01805.
Halpin
D P
DP
Zide
R S
RS
Oberfield
R A
RA
Jewell
E R
ER
D000970:Antineoplastic Agents / Q000008:administration & dosage; D001132:Arm / Q000098:blood supply*; D001916:Brachial Artery; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D007511:Ischemia / Q000209:etiology*; D008113:Liver Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors
D000970:Antineoplastic Agents