title: Thrombotic complications after radial arterial line placement in systemic sclerosis: A case series.
abstract: To demonstrate potential thrombotic complications after radial arterial line placement in patients with scleroderma.
  
  
  
  This is a retrospective case series of 4 patients with scleroderma who were hospitalized in the intensive care unit (ICU) requiring invasive hemodynamic monitoring and developed severe complications after radial arterial line placement. We reviewed their medical records to assess their laboratory findings and clinical presentations.
  
  
  
  All 4 patients met the 2013 ACR/EULAR criteria for systemic sclerosis and had a radial arterial line placement in the setting of invasive hemodynamic monitoring. Overall, 2 of 4 patients had arterial line placement during surgery; while 1 patient had it placed for invasive blood pressure monitoring during an ICU admission for renal crisis; and 1 patient had arterial line placement during cardiac resuscitation, but before administration of vasopressor support. In all, 3 of 4 patients had major ischemic events including digital gangrene, hand auto-amputation, and below-elbow amputation. Among all, 1 patient had temporary hand ischemia with recovery of perfusion with immediate arterial line removal within 24 hours.
  
  
  
  Radial arterial line placement may trigger critical ischemic events in scleroderma patients. This experience suggests that placement of radial lines needs to be thoughtfully weighed prior to insertion in patients with scleroderma, and alternative options should be carefully considered.
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave., MFL-Center Tower, Suite 4500, Baltimore, MD 21224. Electronic address: jpaik1@jhmi.edu.
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Paik
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave., MFL-Center Tower, Suite 4500, Baltimore, MD 21224.
authors.forename: Ram
authors.initials: R
authors.lastname: Hirpara
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Heller
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave., MFL-Center Tower, Suite 4500, Baltimore, MD 21224.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Hummers
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave., MFL-Center Tower, Suite 4500, Baltimore, MD 21224.
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Wigley
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave., MFL-Center Tower, Suite 4500, Baltimore, MD 21224.
authors.forename: Ami A
authors.initials: AA
authors.lastname: Shah
mesh_terms: D000328:Adult; D005260:Female; D005734:Gangrene / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D017534:Radial Artery; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000503:physiopathology*; D013927:Thrombosis / Q000209:etiology* / Q000503:physiopathology; D062666:Vascular Access Devices / Q000009:adverse effects*
keywords: Arterial line placement; Raynaud׳s phenomenon, Systemic sclerosis; Vasculopathy