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Unusual Complication of Transradial Catheterization

Pullakhandam, Naga S., MBBS; Yang, Zhong-jin, MD; Thomas, Sebastian, MD; Wasenko, John, MD

Section Editor(s): Shafer, Steven L.

doi: 10.1213/01.ANE.0000227156.20336.2C
Letters to the Editor: Letters & Announcements

Department of Anesthesiology;, Yang, Thomas)

Department of Radiology; Upstate Medical University; Syracuse, NY (Wasenko)

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To the Editor:

Percutaneous transradial coronary angiography has recently increased in popularity with low theoretical risk of complications (1–4). We report a case in which the cardiologists were unable remove a catheter during transradial coronary catheterization. General anesthesia was used to facilitate catheter removal. A 62-yr-old morbidly obese male was scheduled for left heart catheterization. The cardiologists gained access to his right radial artery without difficulty and immediately administered intraarterial verapamil and nitroglycerine. They then passed a guidewire into the brachial artery with a 5F sones catheter over it. However, they could neither advance nor retract the catheter beyond a certain point in the upper arm (Fig. 1). For presumed vasospasm, the cardiologists administered a widely used “antispasmodic cocktail” (isosorbide mononitrate or isosorbide dinitrate or nitroglycerin and verapamil) for radial artery spasm (5–7). They gave additional verapamil, nitroglycerine, papaverine, midazolam, and morphine—all without effect. Cine injections showed the catheter lodged in an artery, either a small branch of the radial artery or a small native radial artery. They consulted a vascular surgeon, who tried without success to dislodge the catheter. We administered general anesthesia in preparation for possible surgical exploration. Soon after we induced anesthesia and intubated the patient's trachea, we could easily pull back the intact, perfectly formed catheter. Our case suggests that general anesthesia, by causing arterial vasodilation, may be a safe, painless way to remove a catheter lodged in an artery in vascular spasm.

Figure 1.

Figure 1.

Naga S. Pullakhandam, MBBS

Zhong-jin Yang, MD

Sebastian Thomas, MD

Department of Anesthesiology

John Wasenko, MD

Department of Radiology

Upstate Medical University

Syracuse, NY

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