Entrapment of a Transradial Angiogram Catheter Because of Severe Vasospasm

Brachial Plexus Block for Removal of Retained Radial Artery Sheath

In this case, we present a lesser-known application of regional anesthesia, specifically, managing a patient with vasospasm and retained radial artery (RA) vascular sheath after coronary angiography. Providing an ultrasound-guided supraclavicular block, in combination with general anesthesia, allowed the proceduralist to remove the retained sheath after several hours of failed treatment and manipulation. Severe arterial spasm was alleviated by eliciting a sympathectomy, along with analgesia of the right upper extremity, and maintaining this post-procedure. The block optimized arterial flow through the RA post-intervention and helped manage the patients' pain from manipulation.

Regional to the Rescue! Axillary Brachial Plexus Nerve Block Facilitates Removal of Entrapped Transradial Catheter Placed for Cardiac Catheterization

OBJECTIVE

Our objective was to describe the first reported use of an axillary brachial plexus block to treat the entrapment of a transradial artery catheter due to vasospasm.

CASE REPORT

A 42-year-old man undergoing transradial arterial cardiac catheterization suffered arterial vasospasm causing the catheter to become entrapped and refractory to conservative (warm compresses) and standard pharmacologic interventions (intracatheter verapamil, intravenous infusions of nitroglycerin and nicardipine, and subcutaneous lidocaine and topical nitroglycerin). Anesthesia was consulted, and attempts at catheter removal under monitored anesthesia and general anesthesia failed. Finally, in order to avoid surgical intervention, an ultrasound-guided axillary brachial plexus block with mepivacaine was performed, resulting in easy removal of the catheter.

CONCLUSIONS

Axillary brachial plexus nerve blocks are an effective, efficient, and safe intervention with a wide range of indications. This case report demonstrates that an axillary nerve block can be used to treat the entrapment of a transradial artery catheter due to vasospasm.

Radial artery avulsion--a rare complication of transradial catheterization

Transradial access is becoming the default mode of catheterization in a growing number of centers in the United States. The increasing utilization of transradial access has led to significant reduction in access site complications especially bleeding complications. We report a rare complication of transradial catheterization of radial artery avulsion, which was successfully treated in an endovascular fashion during the index procedure. © 2014 Wiley Periodicals, Inc.

Successful removal of an entrapped and kinked catheter during right transradial cardiac catheterization by snaring and unwinding the catheter via femoral access

Since its introduction by Campeau in 1989, the transradial approach for coronary angiography has gained significant popularity among interventional cardiologists due to its lower access site complication rates, cost-effectiveness, and shorter hospital course. Although the transradial approach is much safer than the transfemoral approach, it has its own inherent rare complications including radial artery occlusion, thrombosis, nonocclusive radial artery injury, vasospasm, and compartment syndrome. Herein, we present an unusual case of entrapment and kinking of a catheter in the radial artery, which was successfully removed by using a gooseneck snare via the transfemoral route. The distal and proximal tips were then simultaneously rotated in opposite directions, allowing for the unkinking and removal of the catheter. To our knowledge, this is the first report of this rare complication.