Radial Artery Reconstruction After Iatrogenic Cannulation-Related Occlusion: A Case Report

Abstract

A 59-year-old male, with a history of angiogram via the left radial artery during the workup for multi-trauma, presented to the hand clinic with a 14-day history of progressive critical ischemia in the left thumb and index finger, along with dry gangrene of the distal index fingertip. Radial artery occlusion was confirmed on imaging. The patient underwent radial artery thrombectomy, arterial reconstruction with vein graft, and amputation of the index fingertip. Postoperatively, perfusion to the thumb and index finger was restored, resulting in the resolution of associated pain and hypersensitivity. This case demonstrates the delayed presentation of ischemia following radial artery cannulation, which was successfully managed with radial artery thrombectomy and a saphenous vein graft.

Keywords: digital necrosis; ischemic gangrene; radial artery occlusion (rao); radial artery reconstruction; upper extremity revascularization.

Figure 1. Threatened distal left thumb with mottling of the skin and distal dry gangrene of the left index finger 3.5 weeks following left radial artery cannulation: (A) volar, (B) oblique, and (C) dorsal.

Figure 2. (A) Thrombosis of the left radial artery from the mid-forearm to the wrist (white arrows); (B) the artery was transected proximally with excision of the unhealthy vessel and distal thrombectomy.

Figure 3. (A) Ipsilateral saphenous vein graft was harvested for arterial reconstruction; (B) end-to-end anastomosis of the reversed saphenous vein graft was performed with interrupted 8-0 nylon using the intraoperative microscope.

Figure 4. One-week postoperative follow-up (A, volar; B, oblique; C, dorsal; D, distal thumb) and five-week postoperative follow-up (E, volar; F, oblique; G, dorsal; H, distal thumb).

The index finger amputation site healed without complication. (D) A 1 cm x 1 cm eschar of the distal tip of the thumb was noted at one week, and (H) it subsequently decreased significantly in size with local wound care by five weeks.  All fingers and thumb are pink with one- to two-second capillary refill, and radial pulse is palpable on examination.