Cutaneous zygomycosis following attempted radial artery cannulation

Acute Upper-Limb Complications Following Radial Artery Catheterization for Coronary Angiography

PURPOSE

The radial artery is becoming the vessel of choice for performing cardiac catheterization. Transradial catheterization can impose risks on the upper extremity, and hand surgeons should be aware of the most frequent complications. The purpose of this study was to determine the frequency, timing, and scope of upper-limb complications shortly after transradial catheterization.

METHODS

A retrospective review was conducted of the medical records of patients who underwent catheterization between 2009 and 2016. Complications were assessed for up to 60 days. The Cox model was used to assess risk factors for complications.

RESULTS

A total of 10,540 patients were included in the analysis (68.5% male), median age 67 years. There were 79 patients who experienced at least one complication within 60 days (0.84% of procedures; 95% confidence interval, 0.65% to 1.02%). The most common complications were hematoma (n = 39) and radial artery occlusion (n = 28). Other complications included pseudoaneurysm (n = 7), arteriovenous fistula (n = 3), carpal tunnel syndrome (n = 4), arterial perforation (n = 3), persistent vasospasm (n = 2), and compartment syndrome (n = 1). The complications were diagnosed a median of 1 day after catheterization. Female sex was at increased risk for developing a complication. Diabetes, age, body mass index, and catheter size were not associated with an increased risk for developing a complication. Ten patients underwent surgical management of a complication. Reasons for surgery included symptomatic radial artery occlusions, pseudoaneurysm formation, arteriovenous fistulas, and compartment syndrome. No identifiable risk factors were associated with patients who underwent surgical intervention.

CONCLUSIONS

The frequency of upper-limb complications after radial artery catheterization is small. They include arterial occlusion, bleeding, compartment syndrome, arteriovenous fistula, and pseudoaneurysm. Most complications presented within 1 week of the procedure and occurred more frequently in the female sex. Operative management of complications was infrequent.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Complications related to radial artery occlusion, radial artery harvest, and arterial lines

Recent publications have suggested that there may be an important role for the radial artery regarding long-term perfusion of the hand. The increasing popularity of the radial artery as an access site for cardiac catheterization has also resulted in the recognition of acute and chronic radial artery occlusion, and cardiologists have placed renewed emphasis on preserving the patency of this artery for future interventional procedures. This article reviews the present literature on radial artery harvest and occlusion. Also discussed are the complications associated with radial artery occlusion and treatment options to prevent such complications.

Nosocomial post-traumatic cutaneous mucormycosis: a systematic review

Mucormycosis is a rare, rapidly fatal opportunistic invasive fungal infection occurring in immunocompromised patients. Primary cutaneous mucormycosis usually follows direct inoculation of fungal spores at the site of damaged or traumatized skin. We report a case of fatal nosocomial post-traumatic cutaneous mucormycosis in a diabetic patient and we performed a systematic review of reported cases of nosocomial post-traumatic cutaneous mucormycosis to describe their demographic profile, predisposing factors, treatment and outcome.